The Laurels Care Home

The Laurels Care Home is a residential care home providing care and support to up to 52 people. The service provides care to people aged over 65 years old, some people were living with dementia. At the time of our inspection there were 30 people living at the service and one person in hospital. The home is a purpose built, single storey building.

At the time of our inspection, the service was experiencing a COVID-19 outbreak, with all people being supported to remain in their bedrooms and receiving individualised care and support to reduce the risk of the spread of infection. Some staff were also on sick leave. These circumstances were taken into consideration in the approach taken to completing this inspection.

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

We identified that whilst the service was dealing with safeguarding concerns appropriately, records showed notifications to CQC had not consistently been made in line with their regulatory responsibilities. Further development in certain aspects of the provider’s own audits and checks would ensure consistent adherence to health care professional’s guidance in relation to the repositioning of people to maintain skin health.

Overall, people received their medicines as prescribed, but care records would benefit from further development to ensure staff are clear when to either seek medical input or give people medicine to manage constipation risks. Improvements to the counting in and out of medicines for example when people were admitted to hospital was also identified.

Feedback from people’s relatives was mainly positive, we shared any information of concern with the manager, who was responsive to our feedback, and liaised with people’s relatives directly to resolve concerns or implement changes.

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 were supported by sufficient numbers of suitably trained staff. People’s bedrooms were personalised, and the care environment contained signage and information to support people to independently move within their home.

People were supported to maintain regular contact with their relatives and friends, and to participate in activities in group and on a one to one basis, with activity staff in place. People’s care records were personalised, and provided staff with detailed guidance, including people’s preferences, likes and dislikes.

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

This service was registered with us on 07 April 2022 after the provider sold the service to a new provider, and this is the first inspection. The last rating for the service under the previous provider was Requires Improvement, with Inadequate for Well-led with ongoing breaches of regulations and conditions remaining imposed on the registration, resulting in the service remaining in special measures. The report was published on 15 February 2022.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. We have made some recommendations within the report to support ongoing improvements of the service.

This service has been in Special Measures since 27 January 2021. During this inspection the provider demonstrated that improvements have been made. The service has not been compliant with the regulations, with ratings of requires improvement or inadequate for the last 10 inspections. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains Requires Improvement with no breaches of regulation based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Laurels care home is a residential care home which provides nursing and personal care for up to 52 people aged 65 and over. At the time of the inspection, there were 38 people living in the home. The home is a purpose built one storey building.

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

Improvements were being made to the service and a new registered manager was in post. While the registered manager was working to improve the governance of the service, concerns raised at the previous inspection had still not been fully met. For example, it was identified during the last inspection that there were gaps in the recording on people’s repositioning charts. We made the registered manager aware of this on the first day of our inspection, but actions had not been taken to improve these records. Not all audits had action plans in place. This means that the service has failed to achieve a good rating for the previous 10 inspections and is still rated requires improvement overall.

People were positive about the staff but also told us that staff were too busy to spend time with them. People also told us and staff confirmed that they sometimes had to wait long periods for assistance.

Staff were wearing personal protective equipment (PPE) in accordance with government guidelines more consistently. Cleaning schedules had been enhanced to ensure appropriate cleaning of frequently touched areas. No plans were in place for zoning of areas of the home in the case of infections, however this was put in place immediately.

Improvements had been made to the recruitment process to ensure staff were recruited safely. Staff followed the correct procedures to ensure that medicines were administered as prescribed and in a safe manner.

Care plans would benefit from being more person centred. The personal care sections had improved and were more detailed so that staff had the information they required.

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 Requires Improvement (report published August 2021) and there were multiple breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last ten consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection although some improvements had been made the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in January and February 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Laurels Care Home 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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing levels and governance.

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

Follow up

We will meet with the provider and request an action plan following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures:

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Laurels care home is a residential care home which provides nursing and personal care for up to 52 people aged 65 and over. At the time of the inspection, there were 42 people living in the home. The home is a purpose built one storey building.

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

People were not sufficiently protected against the risks associated with the current COVID - 19 pandemic as infection prevention and control procedures had not been effectively implemented.

We found that staff competency in the administration of medicines was not always sufficient and we observed some unsafe practice. Other aspects of medicines management were however safe.

Care plans and peoples care records did not always accurately reflect or assess potential risks to people so that staff could support them safely. Management oversight of these risks did not identify themes or trends so that action could be taken if required.

The providers recruitment process had not been followed. Some staff had been recruited without all the necessary checks being completed. Supervision of newly recruited staff was sparse and did not contribute to assessing whether they were suitable in their role and understood what was required.

Enough staff were employed in order to meet people’s needs and keep them safe, however these staff were not effectively deployed to ensure people needs were met in a timely manner. Peoples feedback was that they sometimes had to wait long periods of time to receive care. The registered manager did not review staffing needs across different times of the day so that they could see if people’s needs were being met.

Staff understood safeguarding procedures and how to report concerns. They were able to describe to us what they should be observant for and the types of abuse vulnerable people were prone to.

Oversight and management of the service had been insufficient, it had not identified the shortfalls we found on inspection. The registered manager had not implemented an overarching quality assurance system to ensure good and safe care was provided to people. The service had failed to make improvements since the last inspection. People and their relatives felt that the service lacked a managerial presence, and limited information had been shared with them during the pandemic at a time when visitation was difficult.

During the inspection, the registered manager started to take positive action to address these concerns.

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 4 September 2019). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last nine consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention and control. A decision was made for us to inspect and examine those risks. During this targeted inspection, we identified further concerns relating to medicines management and leadership within the home, so we widened the scope of the inspection to a focused inspection of the key questions of safe and well-led.

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

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 COVID-19 and other infection outbreaks effectively.

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

The overall rating for the service has remained requires improvement. However, we have changed the rating for our well-led question to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Laurels Care Home 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe administration of medicines, infection prevention and control, fit and proper persons employed and good governance this inspection.

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

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Home is a residential care home that was providing accommodation and personal care for 40 older people at the time of this inspection. The service can support up to 52 people in one adapted building over one floor.

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

There were quality assurance procedures in place, however they were in the process of being developed. They had not identified where improvements were required.

Care plans were in the process of being reviewed. They did not contain full information about the support that people required. the information staff.

Staff were safely recruited. A system was in place to determine the numbers of staff on duty. However, people told us that at times they had to wait for staff assistance. Staff felt well trained and supported in their roles. One member of staff said, “We are a good team here and we are well supported by the registered manager.”

Potential risks to people had been assessed and measures put in place to reduce these. When accidents or incidents occurred staff took action to reduce the risk of them happening again. The registered manager shared learning with the staff team. Staff supported people to maintain good health and timely referrals were made to health care professionals.

People were supported to eat and drink enough to maintain a balanced diet.

People had access to a wide range of activities in both the community and within the service, that reflected their specific needs and interests.

The registered manager had a good understanding of their responsibilities to notify the CQC of important events that happened within the service.

The registered manager acted on concerns raised to make improvements to people's care.

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 said the staff were very caring and kind and treated them well. They told us staff maintained their privacy and provided the care they wanted.

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 August 2018). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive comprehensive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Our last full comprehensive inspection of this service was in July 2017. At that inspection we rated the home overall as Requires Improvement. At that inspection there were three breaches of legal requirements within the Safe and Well Led areas.

Following that inspection we received a number of concerns regarding the quality of care being provided to people. Therefore, we conducted a focused inspection in November 2017 that concentrated on the Safe and Well Led areas only where we found breaches of five regulations. This was because the provider had failed to ensure that: risks to people’s safety had been adequately managed and that people received their medicines correctly; staff had the appropriate skills and knowledge to provide people with safe care; the home and some equipment that people used was clean; robust systems were in place to assess and monitor the quality and safety of care provided to people and that certain incidents had been reported to the Care Quality Commission (CQC) as required by law. The home was therefore rated as Inadequate and placed in special measures. Services that are in special measures are kept under review and inspected again within six months from the publication of the report. We expect services to make significant improvements within this timeframe.

During this latest inspection the manager and provider demonstrated to us that improvements had been made and the home is no longer rated as inadequate overall or in any of the key questions. Therefore, this home is now out of special measures. The provider is no longer in breach of any of the regulations that we found at our inspection in November 2017. However, further improvements are needed in some areas as detailed further below.

The Laurels Care Home is a ‘care home’. The provider advertises themselves as providing specialist care to people living with dementia and who are frail. It is registered to provide care for up to 52 people and care is provided on one floor. At the time of the inspection there were 26 people living in the 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.

There was a manager at the home and they have applied to register with the CQC. 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 home is run.

People felt safe living in the home and systems were in place to protect them from the risk of abuse. Risks to people’s safety and individual needs and preferences in the main, were managed well. However, the guidance provided to staff on how to manage these risks and meet people’s individual needs and preferences was variable in its quality. This included at the end of their life.

Most people had received their medicines correctly although some had not for a short period of time which had not been identified in a timely fashion by the provider. Therefore, this requires an improvement to the provider’s current quality monitoring systems so they are more robust to identify such issues to enable the necessary action and improvement to be made. The manager told us during the inspection visit that these would be implemented immediately.

There were enough staff to keep people safe and to meet their needs. New staff working at the home had been subject to the appropriate checks before their employment began designed to check they were safe to work within care. Most of the communal areas within the home, people’s rooms and the equipment that people used was although there were some offensive odours in two areas that the manager was actively trying to reduce.

Any incidents or accidents that had occurred had been reported, investigated and learnt from. People who lived in the home, those who were close to them and the staff were involved in improving the quality of care that was provided by providing regular feedback to the manager and provider.

Staff had received training in a number of different areas to provide them with the skills and knowledge to support people effectively. Further training was to be provided to staff regarding dementia care to help them develop their skills further and gain confidence on how to assist people who may regularly become upset or distressed. Staff also received adequate support and guidance in their roles.

People received enough to eat and drink to meet their individual needs. Religious and cultural aspects of their care were respected. Consent was obtained from people before any care was given. Where people could not consent, staff acted in line with the relevant legislation and only made decisions on people’s behalf in their best interests.

People received stimulation from a range of activities that were on offer. This included one to one chats within people’s rooms. This was being developed further in conjunction with the people living in the home and their relatives.

People were offered choice and were involved in making decisions about their own care. The staff were kind and caring and treated people with dignity and respect. People and staff were able to raise concerns or complaints without fear which demonstrated an open culture. Any complaints or concerns raised had been appropriately investigated and dealt with.

People’s healthcare was monitored and any needs met. Relationships had been developed with outside healthcare professionals who visited the home regularly in response to any concerns raised.

Governance and quality monitoring had improved, but still required further amendments to ensure it was robust. Audits and checks in place to monitor the quality of the service had not found some of issues that were present during our inspection. The manager and provider were open to suggestions for improvement and had a plan in place to drive up the quality of the service provided.

The staff were happy working at the service, felt very supported by the manager and provider and worked well as a team to deliver care to people.

There was a registered manager working in the home. 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 our last inspection in July 2017 we rated this home overall as Requires Improvement. After this inspection that overall rating has been reduced to Inadequate.

This inspection site visit took place on 27 and 29 November 2017. The first day was unannounced. It was conducted in response to concerns we had received since our last inspection in July 2017, about the quality of care people were receiving. The concerns related to staffing levels, continence care, staff training/competency, cleanliness and infection control practices and bruising that some people had sustained. As these concerns related primarily to people’s safety, we decided to inspect the following two key questions: is the service safe and is the service well-led? No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At our last inspection in July 2017, we found three breaches of legal requirements within the safe and well-led key questions. This was because the provider had not ensured the care people received was safe or that all equipment and areas of the premises were clean. They had also failed to ensure that robust governance processes were in place to effectively assess and monitor the quality of care people received.

We asked the provider to complete an action plan to show what they would do and by when to meet these legal requirements. They told us these would be fully met by 10 October 2017. As they told us they would be meeting these requirements at the time of this inspection, we checked to see if improvements had been made. We found that the required improvements had not been made and that the provider continued to be in breach of these three legal requirements.

In addition, we found two further breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Staff understood how to reduce the risk of people experiencing abuse. However, some risks to people’s safety had not been adequately managed or reviewed to ensure that all necessary actions were being taken to keep people safe. This placed people at risk of avoidable harm.

The registered manager or provider had not effectively monitored staff practice and competency to perform their role safely. This resulted in some staff performing care tasks without first receiving the necessary training, resulting in poor care practice that placed people at risk of unsafe care.

People’s medicines were poorly managed. Accurate records had not been kept and therefore, the provider could not give themselves assurance through their existing auditing systems that people had received their medicines correctly.

The provider had assessed the number of staff that were required to meet people’s needs and to keep them safe. However, these numbers had not been consistently met. Therefore, people sometimes had to wait for the care and support they required. This had in the main, been due to high levels of staff sickness that the registered manager and provider were actively trying to resolve. We saw this was reducing but continuing improvements are required.

Since December 2014, the provider has not been able to achieve a rating of Good. There have been a number of regulation breaches over this time and where any improvement has been made, the provider has not always been able to maintain this. At this inspection we again found that the provider’s governance systems were not robust enough to drive improvement and to monitor and assess that people received a level of good, safe care.

The provider or registered manager had not notified the CQC of certain incidents that had taken place within the home, as is required by law.

There was an open culture in the home where people and staff felt able to raise concerns without fear of recrimination. However, not all staff felt consistently valued or appreciated.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A registered manager was in post. 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.

Our previous inspection carried out in January 2017 identified six breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the home as Inadequate, placed it in special measures and told the provider they could not admit any new people to the service. We also told them that they had to regularly send us evidence of how they monitored risks to people in respect of not eating and drinking, developing pressure ulcers, choking and falls.

At this inspection we found that some improvements had been made. However, further improvements are still required and the provider remains in breach of two of the previous Regulations. These are in respect of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a new breach in respect of Regulation 15. We have now rated the home as Requires Improvement.

People had been placed at risk of avoidable harm. Not all risks to people’s safety had been adequately assessed or actions taken to mitigate an identified risk. Communication to staff in relation to risks to some people’s safety had not always been effective resulting in poor practice.

The monitoring of staff practice to ensure they were competent to perform their role safely had not been regularly assessed. Some areas of the home and some equipment people used was unclean. Not all of the provider’s current systems to monitor the quality and safety of the service were effective at identifying and mitigating risk to people’s safety.

The provider had ensured that systems were in place to protect people from the risk of abuse and most people had received their medicines correctly and when they needed them. However, the provider had not ensured that the number of staff they deemed were necessary to meet people’s needs, were consistently in place. This sometimes impacted on the staff’s ability to provide people with individualised care.

People received sufficient amounts of food and drink people to meet their individual needs. They were supported to maintain and improve their health. People had access to activities that supported their own hobbies and interests. These also provided them with stimulation and improved their wellbeing.

The staff were kind, caring and treated people with dignity and respect. They asked people for their consent and acted in people’s best interests if they were unable to consent to their care. Staff offered people choice and involved them in making decisions about their care. However, the caring approach of the service was not consistent with some people experiencing unclean equipment, having to wait for staff assistance when they needed it and being exposed to some potential harm.

People were listened to and any concerns they raised were investigated and learnt from. People and staff were involved in driving improvement within the home and had regularly been asked for their suggestions and feedback which had been acted upon.

The registered manager was keen to improve the quality of care people received. They were open and told us that further improvements were needed. Any issues we raised with them were immediately dealt with.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The Laurels Care Home is a care home that provides accommodation and personal care for up to 52 people. The provider’s website describes the service as one that ‘specialises in round the clock dementia care and care for frail people.’ At the time of our visit, there were 41 people living in the home, the majority of who were living with dementia.

There was a manager registered with the Care Quality Commission (CQC) as is required. 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 and associated Regulations about how the home is run. Following our inspection in September 2016, the registered manager stepped down from their post within the home but did not de-register with the CQC. The head of care took over the running of the home as the manager but they subsequently left their employment in December 2016. The previous registered manager who was working as the deputy manager in the interim resumed managing the home. At this inspection, a director of the provider (who will be referred to in the report as ‘the provider’), told us this arrangement was temporary until a new manager started on 16 January 2017.

At our last inspection on 28 September 2016 which had been a focussed inspection in response to concerns we had received, we asked the provider to take action to make improvements in respect of the quality of care that was provided to people. At this inspection, we found that the necessary

improvements had not all been made. This resulted in six breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we have told the provider to take at the back of the report.

There were not enough staff working in the home to keep people safe and to meet their preferences. This also impacted on people receiving adequate stimulation to enhance their wellbeing and reducing the risk of them experiencing abuse. In most cases, risks to people’s individual safety had been assessed but actions had not always been taken to mitigate these risks. Some people had therefore experienced poor care or had been put at risk of harm.

Some areas of the home and equipment people used were unclean and not all risks in relation to the safety of the premises had been assessed.

People’s medicines had not all been managed well and people continued to be inadequately supported to eat and drink enough to meet their individual needs. Some staff had received adequate training to perform their roles however, others had not which placed people at risk of receiving poor care. Some staff demonstrated poor care practice which placed people at risk of infections. There was a lack of evidence to support that staff care practice was regularly assessed and monitored to ensure they were competent at their role.

There continued to be a lack of effective governance and leadership in place to assess, monitor and mitigate risks in relation to people receiving poor quality care.

People were supported with their healthcare needs but staff did not always follow the advice of healthcare professionals. When people raised concerns, these had not always been taken seriously or investigated appropriately. Some people’s dignity and privacy was not upheld.

Staff sought consent from people in line with the relevant legislation and the necessary checks had been made before staff started working in the home to ensure they were eligible to work within a care setting. People and their relatives were involved in making decisions about their care as much as they wished to be.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying

the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

The Laurels Care Home is a care home that provides accommodation and personal care for up to 52 people. The provider’s website describes the service as one that ‘specialises in round the clock dementia care and care for frail people.’ At the time of our visit, there were 45 people living in the home, the majority of whom were living with dementia.

The home had a 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 and associated Regulations about how the service is run.

Risks to people’s safety had not always been assessed. Where they had been, adequate actions had not always been taken to keep people safe.

Not all people living within the home had received adequate support to ensure they received enough to eat and drink to meet their individual needs. This had resulted in some people losing a significant amount of weight.

There were a lack of effective systems in place to assess and monitor the quality of care provided to people. The provider had not followed their own policies in respect of how to meet people’s eating, drinking and pressure care needs.

We carried out an unannounced, comprehensive inspection of this service on 1 December 2014. As a result of our findings we found a breach of two legal requirements. We asked the provider to make improvements to ensure people received sufficient food and drink and that suitable arrangement were in place for obtaining lawful consent in accordance with the Mental Capacity Act 2005 (MCA). The provider’s representative wrote to us detailing how and when improvements would be made.

This unannounced inspection took place on 23 May 2016. There were 41 people receiving care at that time.

We found that sufficient improvements had been made to ensure people received enough to eat and drink. We also found that some improvements had been made towards compliance with the MCA.

The service had a registered manager in place. 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.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were trained, and supported, by the registered manager. There were sufficient staff to safely meeting people’s needs. However, staffing levels limited the choices people were able to make and how individualised their care was.

Good infection control procedures were not always followed and people were not always cared for in a hygienic and fresh smelling environment. There were systems in place to ensure people’s safety was managed effectively. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People received their prescribed medicines appropriately and medicines were stored safely. People’s healthcare and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making. The registered manager had prioritised the applications that needed to be made to the authorising agencies for people who needed these safeguards and had an action plan in place for achieving this. Staff respected people choices and decisions. Staff had received training in the MCA and DoLS, but this knowledge needed embedding.

People received care and support from staff who were kind, caring and compassionate to the people they were caring for. People had opportunities to comment on the service provided and people were involved in every day decisions about their care.

People’s care records were brief and did not provide staff with sufficient guidance to ensure consistent care to each person. Care was often task orientated. There were opportunities for people to participate in activities. However, these were limited, particularly for people who required one to one staff support.

The registered manager was supported by a staff team that included a deputy manager, team leaders, care workers, and ancillary staff. The registered manager was approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. Concerns were investigated and improvements made. However, the quality assurance system had not identified all areas where improvements were needed

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

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

This is a summary of what we found:

Is the service safe?

People are treated with respect and dignity by staff. They told us that they liked living at The Laurels Care Home. People were consulted and involved in planning their care. The care and support needs of people had been assessed and reviewed to ensure they were provided with the care and support they needed.

Staff were trained and knew how to provide care and support to people. This meant that the staff members employed had the qualifications and skills needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS) to ensure that people who could not make decisions for themselves were protected. Policies and procedures were held. Staff had been trained and knew when a DoLS application was needed. The manager told us that there had been no reason for a DoLS application to be made. The manager showed us that they knew how to submit a DoLS application.

Is the service effective?

People's health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person living at the service told us. 'It is nice here and the staff are lovely.' Staff had received suitable training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that the staff provided them with the care and assistance they required. Our observations confirmed this. A relative told us, 'I am happy with the care given to my family member. The members of staff are polite and respectful.'

Is the service responsive?

Care and risk assessments had been written and regularly reviewed. The care and support provided was adjusted to meet the needs of each person. Changes in a person's care and support had also been recorded in their plans of care. A record was held of people's preferences, interests and diverse needs so that these could be respected by staff. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People received the individual support they needed and had access to a range of planned activities

Is the service well led?

Staff spoken with had an understanding of the ethos of the home. People said that they felt listened to when they made a suggestion or raised their concerns. They told us that the manager and staff were approachable and that the service was well organised. The records we looked at and our observations confirmed this.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required. One person told us that their meals were, "Always very nice".

The home and grounds were appropriately maintained. Equipment was properly checked and serviced on a regular basis. There were no offensive smells during our inspection, although this had been mentioned in the annual survey and in one of the provider visit reports.

Staff rotas and training information showed there were enough staff members and that training had been kept up to date. People using the service and said there were enough staff available to meet their needs.

Systems were in place to regularly check and monitor the way the service was run.