The Laurels Residential Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

This service scored 61 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. The provider had not always focused on learning and continuous improvement; however, progress had been made in this area. The leaders had a clear vision to drive the necessary improvements and provide a homely environment where people were supported to make their own choices and receive safe, person-centred care. The manager told us, “I want to turn it around; I want it to be person-centred, have a holistic approach where everyone is treated with dignity, including staff. I want to make sure we are caring, respectful and compassionate.”

There had been recent changes within the staff team, which had impacted stability. The manager was implementing new ways of working to embed positive practice and drive improvement. Staff were optimistic about these changes, with one staff member telling us, “I feel we can get there. The manager is making changes.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. There had been several recent changes within the staff team; however, the manager told us they felt well supported by their area manager. The manager had increased their visibility within the service through daily walkarounds, which supported oversight and engagement with people and staff. Staff described managers as approachable, although some told us communication could be further improved. Feedback about the new manager was positive, with one staff member telling us they “really like the new manager” and describing a “fresh attitude,” adding that positive changes had already been made.

People did not always feel they could speak up and that their voice would be heard. Systems were not effective in ensuring staff were protected when raising concerns. For example, one whistleblowing disclosure was not managed sensitively and had been discussed openly during staff meetings. Although an investigation was undertaken, it focused on identifying the individual who had raised the concern, which may discourage staff from speaking up again in the future.

However, staff were encouraged to raise concerns and told us they felt able to approach managers to discuss any issues. Staff were also provided with opportunities to share their views through regular supervision and team meetings to encourage staff engagement.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff had received equality, diversity and inclusion training and were supported through regular supervision. Staff told us they had not experienced discrimination within the service. However, one staff member told us they did not always feel fully included within the team and described some shifts as “lonely”, indicating opportunities to further improve team cohesion and support.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Governance systems were either missing or not always effective in identifying areas of concern, particularly in relation to medicines management, incident reporting, analysis and care planning. The provider failed to have effective oversight of the training matrix to ensure staff were appropriately trained to support people's current specific needs. Whilst some scheduled audits were in place and some issues had been identified and addressed appropriately by the management team, oversight was not always consistent. For example, health and safety actions were not always recorded within improvement plans or signed off once completed. Systems were missing regarding identifying trends and themes in behaviours communicating an unmet need. This meant underlying concerns were not addressed causing repeat behaviours and further distress to people.

A new manager had been appointed who was supported with the day to day running of the home by the area manager. At the time of our assessment, the manager had submitted their application to CQC to become registered. The manager acknowledged these shortfalls and had already implemented improvements by introducing more robust audit processes. Further time was required to ensure that improved practices were sustainable and embedded.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. Staff and leaders demonstrated an open and transparent approach and worked collaboratively with external stakeholders and partner agencies. Care records evidenced timely and appropriate referrals to external health professionals, with guidance and outcomes shared with the wider staff team through daily meetings to ensure continuity of care.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research. Learning from previous regulatory feedback had not been implemented and issues were still found at this inspection. Whilst we had identified missed opportunities in learning, the manager was receptive to feedback and had begun taking action to address issues identified during the inspection.

Ongoing improvement work included the installation of a new call bell system, fire alarm and electronic care planning system to support safer care, improve outcomes for people and strengthen oversight. The manager had identified gaps within the new care planning system and was liaising with the supplier to provide feedback and implement improvements.