The Laurels Residential Care Home

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 requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

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.

Incidents were not always appropriately reported or escalated, although they had been recorded. This meant opportunities to learn from events were missed and necessary updates to care plans were not always completed, potentially impacting people’s care and safety. There was a lack of effective management oversight to identify trends and themes, which limited learning and did not support reducing the risk of similar incidents occurring. However, staff told us they understood how to report incidents, indicating awareness of the reporting process and the provider had identified some learning through their own audits. Systems had been introduced to strengthen learning and support continuous improvement going forward.

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.

Systems were in place to support safe transitions into the service. The manager completed all assessments face to face, ensuring people’s needs could be appropriately met. This reassured people when moving in. One person told us, "[Name] met me at my home, she's a nice lady." When another person was discharged from hospital without the necessary equipment, the manager acted promptly to source this, ensuring safe and continuous care. Relevant information regarding new admissions was shared with staff in a timely manner, enabling people to receive appropriate care and support from the outset. Staff confirmed this process was consistently followed. Where external referrals were required, these were completed in a timely way and outcomes were clearly documented within people’s care plans.

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 had received safeguarding training and demonstrated a good understanding of how to recognise and report abuse. Effective safeguarding systems and processes were in place, including a structured approach to Deprivation of Liberty Safeguards (DoLS), with any restrictions clearly documented within people’s care plans. A monitoring system had been implemented to ensure DoLS were reviewed on a regular basis. Improvements had also been made to the management of people’s finances and valuables, with systems now more robust and operating effectively. Relatives spoke positively about the care provided and told us, “They really look after my family member” and “Yes, I feel they are safe.”

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.

Care records did not always provide sufficient guidance to support safe care. Where thickeners were prescribed to be added to resident drinks, administration records lacked detail on how much thickener was used. We cannot be assured people had their drinks thickened appropriately, which placed them at risk of choking and some choking care plans lacked the necessary detail to guide staff effectively. In addition, some care plans were incomplete or missing key information, including the absence of a diabetic care plan for one individual, insufficient detail within epilepsy care plans, and a lack of information relating to Parkinson’s care. Not all staff were aware that one person had epilepsy. Care plans had also not always been updated in a timely manner following several incidents of behaviour that communicated a need. This placed people at potential risk, as staff may not have had access to clear and accurate information to meet their needs safely.

We observed staff using safe moving and handling techniques when supporting people.

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.

We identified a number of environmental concerns which did not fully support health and safety. These included the absence of a suitable facility to safely charge a mobility scooter and a smoking area located directly outside a fire exit. Action was taken promptly to address these issues, including relocating the smoking area to a safer location.

The provider had all the required health and safety certificates and equipment safety checks were completed and up to date. A new fire alarm system had also been installed to further enhance safety. Staff had received fire safety training, and there were several trained fire wardens within the service.

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 training was not always up to date. Gaps were identified in key areas, including de-escalation, epilepsy, and diet and nutrition. Some staff confirmed they had not received the relevant training required for their roles. The manager allocated this training to all staff for immediate completion to address these shortfalls in response to this feedback.

There were gaps in recruitment practices; however, a new compliance check had been implemented to strengthen safer recruitment processes. Staff told us fire drills were carried out regularly, supporting preparedness in the event of an emergency. Staff also received regular supervision, providing opportunities for support and professional development.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. Some concerns were identified which did not always support effective infection prevention and control (IPC). Towels were not always available in people’s rooms when required, and some bins were observed without lids or containing personal protective equipment (PPE), which was not in line with best practice.

However, overall, the home was clean and tidy. The cleaning team had implemented a more robust cleaning schedule to maintain standards in response to our feedback.

Regular IPC audits were carried out, and staff had access to sufficient PPE. Staff had received training in IPC to support safe working practices. The manager completed daily walkarounds to monitor the environment and address any IPC issues promptly.

The provider did not always make sure that medicines were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Systems for the safe management of medicines were not always effective. Storage arrangements for medicines were not always safe, with some items kept on the floor. Medication room and fridge temperatures were not consistently monitored, meaning we could not be assured that medicines were stored safely or that records were accurate. Protocols for ‘as required’ (PRN) medicines did not always provide clear guidance, particularly where variable doses were prescribed. Whilst people had PRN medicines for pain relief, it was not always recorded why these were administered, which meant staff could not effectively monitor for new or prolonged symptoms. Staff did not always record the level to which drinks had been thickened for people at risk of choking, and we could not be assured that thickened fluids were prepared in line with prescriber instructions. Where medicines were administered covertly, appropriate processes were not always followed. We discussed our findings with the registered manager who responded positively and confirmed that a full audit of medicines would be undertaken on a regular basis to improve standards.

People who required time-critical medicines received these as prescribed and one person told us, "I receive my medication on time." Allergy information was accurately recorded.