Archived: Laurel Lodge Care Home

This inspection took place on 17 May 2016 and was unannounced. It was carried out to establish whether improvements had been made regarding areas of concern that we identified at our previous two inspections. This report only covers our findings in relation to the key question of whether the service provided safe care.

Laurel Lodge is registered to provide accommodation and personal care for up to 27 older people. There were 25 people living at the home at the time of our inspection.

At the time of this inspection there was a registered manager 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. The registered manager was also a partner in the business and therefore the provider. The registered manager has been referred to as the provider throughout this report. There was also a home manager in post who was managing the home on a day to day basis. This person has been referred to as the home manager throughout this report.

When we inspected this service on 17 March 2016 in relation to the key question of safe, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection we asked the provider to send us an action plan of how they intended to address the breach of the Regulation. We did not receive the action plan from the provider..

We then undertook a comprehensive inspection of this service on 26 April 2016. During this inspection we found a repeated breach of Regulation 12. We also found at that inspection breaches of Regulations 11 (consent), 12 (safe care and treatment), 15 (premises and equipment), 17 (good governance), 18 (staffing) and 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection we asked the provider to send us an action plan of how they intended to address the breaches of the Regulations. At the time of writing this report we had not yet received an action plan.

As a result of our inspection in April 2016 the service was placed in special measures.

We found during this inspection that the provider still did not ensure that all reasonable steps were taken to ensure the risks to people were minimised. Risk assessments were still inadequate. Where risks had been identified the provider had still not taken effective action to reduce the risks in a timely way.

You can read the report from both our focussed inspection on 17 March 2016 and our comprehensive inspection on 26 April 2016 by selecting the 'all reports' link for 'Laurel Lodge Care Home' on our website at www.cqc.org.uk.

We have not changed the rating for the key question of safe following this inspection.

This inspection took place on 26 April 2016 and was unannounced.

We previously undertook a comprehensive inspection at this service on 15 June 2015. At that inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection we asked the provider to send us an action plan of how they intended to address the breach of the Regulation. We did not receive the action plan from the provider. During this inspection we found a repeated breach of Regulation 11.

We then inspected this service on 17 March 2016 in relation to the key question of whether the service provided safe care following a concern raised with us. At that inspection we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection we asked the provider to send us an action plan of how they intended to address the breach of the Regulation. We did not receive the action plan from the provider.

At the time of this inspection, in April 2016, there was a registered manager 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. The registered manager was also a partner in the business and therefore the provider. The registered manager has been referred to as the provider throughout this report. There was also a home manager in post who was managing the home on a day to day basis. This person has been referred to as the home manager throughout this report.

The provider was not taking appropriate action to manage risks. Risks were not always identified and there was no clear guidance in place for staff to follow to manage all risks effectively. Risks around the accommodation were not identified and action was not taken in a timely way to reduce the risks to people living at the home.

There was no system in place to assess how many staff were required to meet people’s needs effectively. Staff did not all receive the training and supervision that they needed to meet people’s needs. Staff did not have a good understanding of the Mental Capacity Act and how this should be implemented to ensure people’s rights were restricted lawfully.

Medicines were stored appropriately but there were unexplained gaps in the administration records. People were referred to healthcare professionals appropriately.

The home was not clean and not always well maintained. The was a lack of systems in place to prevent the risk of infection.

Improvements were needed with regard to the provision of meaningful activities for people to take part in.

The provider did not have an effective governance system to monitor the quality of the service and identify the risks to the health and safety of people. Effective audits were not being carried out. The provider had not picked up issues that were identified in this inspection and had not taken appropriate action to make improvements when we had identified them at previous inspections.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

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.

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.

Laurel Lodge is registered to provide accommodation and personal care for up to 27 older people. There were 25 people living at the home at the time of our inspection.

We carried out an unannounced inspection of this service on 17 March 2016 following concerns about how environmental risks are managed.

At the time of this inspection 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. The registered manager is also a director of the company who are registered as the provider of the service.

This report only covers our findings in relation to the key question of whether the service provided safe care. We previously carried out a comprehensive inspection on 11 June 2015 at which we rated the service. You can read the report from our comprehensive inspection of 11 June 2015, by selecting the ‘all reports’ link for ‘Laurel Lodge Care Home’ on our website at www.cqc.org.uk. We have not changed the rating for the key question of safe in this report and will return to carry out a comprehensive inspection at the home at which we will provide an updated rating.

We found during this inspection that the provider did not ensure that all reasonable steps were taken to ensure the risks to people were minimised. Risk assessment's were inadequate, did not consider the risks and did not provide clear guidance to staff about how to manage risks. Where risks had been identified the provider had not taken action to reduce the risks in a timely way.

We reviewed the evidence we had obtained during our inspection and used this to answer five key questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

We observed that people were looked after by attentive and caring staff who ensured they were further supported, when required, by a range of healthcare professionals.

People we spoke with told us that they felt safe living in Laurel Lodge Care Home. Whilst safeguarding and whistleblowing policies were not readily available to staff, those staff members we spoke with understood how to ensure people were protected and knew what action to take if they had any concerns.

We found that the service did not always complete care plans to meet people's specific needs in relation to health conditions they had, or when changes in their health occurred. Care records and risk assessments were not reviewed following changes to people's care needs. Therefore we could not be certain that people always received care which reflected their needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to people living in care services. The provider's service managers had undertaken training which ensured they knew how to recognise when concerns might arise and what action they would be required to take to protect people who could not make decisions for themselves.

Is the service effective?

Staff made sure they obtained people's consent before any assistance was provided. People we spoke with confirmed that staff consulted with them verbally on a frequent basis about the care they received. Most people were able to consent to the care they received, however some people were not able to consent all of the time due to health conditions they were living with. However, no mental capacity assessments had been carried out to assess their ability to make decisions as required by the Mental Capacity Act 2005.

Staff training was inadequate. Some topics such as infection control and the control of substances hazardous to health staff had not received training in. Where staff were due to receive training in other topics this was often very out of date or no dates had been recorded at all. We were told that staff had not received appraisals or supervisions for at least three years. This meant that they were not adequately trained or supported by the provider to ensure that people's needs were effectively met and their welfare was protected.

Is the service caring?

We had no doubts that the staff were caring. There was a friendly atmosphere in the home and whilst people were being assisted, staff spoke with them in a warm and calm manner. We noted that people and staff shared many jokes.

On one day of our inspection some people had chosen to eat lunch outside. Every effort had been made to ensure people were comfortable and enjoyed their meals. Table cloths were laid, condiments, napkins and flowers were on the tables. The gardens were well cared for and contained an abundance of plants and hanging baskets. It was lovely environment which people appreciated.

At one point during our inspection we saw that one person had become upset. A staff member went over to them, sat with them and re-assured them. We saw they took the person's hand in theirs and spent a good amount of time with them, listening to them, ensuring they had everything they needed and just chatting with them.

Is the service responsive?

The service had not received any complaints in the year prior to this inspection. Information was available to people in the main hallway of the home which informed people, or visitors, how to raise any concerns. People we spoke with told us they had no complaints, but if they did they would happy to speak with staff about them.

We saw that people had access to a wide range of healthcare professionals and staff were timely in requesting their assistance to help ensure that people's day to day needs were met.

Is the service well led?

There were shortfalls in the way the home assessed and monitored the service provided. We found few systems were in place to identify, monitor and manage risks to the service people received.

People's care and welfare needs were recorded in their care plans and the records seen showed us that these were being met by staff. This demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff spoken with confirmed that they had received an initial induction to the service and that they received support as needed from senior staff. This showed us that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We saw people receiving assistance with their personal care needs as required and that call bells were answered promptly. This and the other evidence seen demonstrated to us that there were enough qualified, skilled and experienced staff to meet people's needs.

We saw examples of care records and medication audits having been carried out by senior staff and noted that where concerns had been identified, actions to address these had been taken. This meant that the provider had an effective system to regularly assess and monitor the quality of service that people receive.