Laurel Bank

Laurel Bank is a care home providing nursing and personal care for up to 67 people. At the time of our inspection there were 61 people using the service.

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

The registered manager and staff worked closely and transparently with partner agencies to ensure people were protected from harm or abuse. They reviewed their processes to check they continuously maintained people’s safety, including risks linked to, for instance, choking and malnutrition. The registered manager ensured staffing levels were sufficient to support people in a timely way. One person stated, “I feel safe here because there is always a staff member close by.”

Staff files contained sufficient evidence to demonstrate appropriate staff were recruited, inducted and trained to support vulnerable people safely. Staff followed the person’s medication care plan, risk assessment and preferences, such as when they chose to self-administer. One person said, “I was glad they agreed [for me to self-administer]. I know they’re taking a risk, but they trust me and it means I can keep my independence.”

The registered manager had created clear lines of communication for staff to understand their responsibilities in retaining people’s safety and wellbeing. They sought feedback from staff, external professionals, people and their relatives about care delivery and service development. A visiting professional told us, “I’m here all the time and, without exception, I see how caring the staff are. I can confidently say they love the residents in the way they interact with them.”

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 the service under the previous provider was good, published on 07 March 2020.

Why we inspected

The inspection was prompted in part due to concerns received about nutritional risk management and staff training. A decision was made for us to inspect and examine those risks.

The provider has taken effective action to mitigate the risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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.

Laurel Bank is a residential care home providing personal and nursing care to 60 people at the time of the inspection. The service can support up to 67 people.

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

We found some records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. We found no impact to people however, this could have compromised the quality and safety of the service provided. We have made a recommendation about this. There was a positive staff culture at the service. We found the management team receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested.

Medicines were not always managed safely. We found examples where people had not been given their medication in line with guidance. We found no impact to people however, people could have been exposed to risk. We have made a recommendation about this. Medicines administration was person centred. People were given time to take their medicines in a calm and patient manner.

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. We found some inconsistencies in documentation for MCA. We have made a recommendation around this. People were involved in their care planning. People told us they enjoyed the food and they were offered choice.

People told us they felt safe living at Laurel Bank. We were told and could see from observations there were enough staff to meet people’s needs. One person told us, “I wouldn’t be here if I didn’t feel safe, I’m too safe if anything.” People were given their medicines by staff who were trained to do so. The service was clean and tidy throughout and staff followed good infection prevention practices.

The service had an extensive programme of resident led activities. All the people who lived at the service told us they were happy with the activities and they enjoyed them. Staff had undergone training with a local hospice and understood the importance of supporting people to have a good end of life as well as living life to full whilst they were fit and able to do so.

The service was caring. Staff were aware of how to protect people’s privacy and dignity and people told us the staff did this well. One person said, “The staff look after me really well.” People told us the staff were kind and caring. One person said, “People felt supported to make decisions about their daily lives.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 9 March 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the service had improved to Good.

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.

At this inspection visit carried out in February 2019, we found the registered provider had worked hard to make improvements but not all required improvements had been made.

Laurel Bank is a purpose-built home, registered to provide accommodation for up to people who require nursing or personal care. Accommodation is provided for up to 67 people. All bedrooms are en-suite and are located on two floors, served by a passenger lift. There are two double rooms available for those who wish to share facilities. At the time of the inspection visit 43 people were receiving care and support at the home.

Laurel Bank is a 'care 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.

At the time of the inspection visit there was 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. We used this inspection visit to ensure all amendments had been made. We found some, but not all improvements had been made.

At this inspection visit carried out in February 2019, we found paperwork was not consistently accurate, complete and readily available. This was a continued breach of Regulation 17 of the Health and Social Care Act (2008) Regulated Activities 2014, Good Governance.

Additionally, we identified good practice guidance had not been consistently implemented to ensure the safe management of medicines. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014, Safe Care and Treatment.

Auditing systems had been reviewed to ensure audits carried out reflected what was happening at the home so action plans could be developed and maintained. Oversight at the home from senior managers had increased to ensure the service was well-led. Lessons had been learned from the previous inspection visit.

People, relatives and staff told us they had seen an improvement in how the home had been managed since the new management team had been appointed following the last inspection visit.

We found deployment of staffing had improved. Work had been carried out with the staff team to ensure staff responded in a timely manner. When people made requests for assistance we saw their needs were promptly addressed. People who lived at the home spoke highly of the staff and their attitude. We noted staff were patient and respectful with people.

A new call bell system had been fitted within the home which could monitor and record call bell response times. Additionally, the new registered manager had reviewed how staff were deployed in line with the staffing calculator on each unit. Although improvements had been made we noted there was only one call bell alarm in each lounge. We have made a recommendation about this.

We saw risk was sometimes appropriately addressed and managed. We have made a recommendation about this.

We looked at recruitment and noted good practice guidance wasn’t consistently followed to ensure all relevant information was contained within the recruitment checks. We discussed the importance of this with the senior management team and they agreed to carry out a full audit of all files to ensure all information was documented. We received confirmation this had commenced before the inspection visit was completed. We have made a recommendation about this.

People we spoke with told us they felt safe living at the home. The registered provider had made improvements to ensure people who lived at the home were protected from harassment and abuse. This included being aware of the local authority safeguarding process and appointing staff to be safeguarding champions.

We saw person-centred care was delivered to people who lived at the home. Staff were aware of people’s likes and dislikes and work was taking place at the home to enhance individualised care.

We observed activities taking place within the home. Personalised one to one activities took place as well as group activities. This ensured activities were person centred and inclusive to all.

Training had been provided to ensure staff were equipped with the necessary skills required to carry out their role. We saw staff working appropriately and putting their skills in practice.

People told us they were extremely happy with the choice and quality of food provided. People’s dietary needs were met in line with good practice guidance. Support was given in a respectful manner if people required support at meal times.

The registered provider was working to ensure the mental capacity and consent of all people who lived at the home met good practice guidance. When people were being deprived of their liberty, the registered provider had taken the required action to ensure this was done lawfully.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We looked at how complaints were managed and addressed by the service. When complaints were raised they were dealt with professionally and in a timely manner.

The overall rating for this service is ‘Requires Improvement’. This is the second time the service has been rated as Requires Improvement.

You can see what action we have asked the provider to take in the main report.

Laurel Bank is a purpose built nursing home situated close to the city centre of Lancaster. Accommodation is provided for up to 67 people needing assistance with personal or nursing care. All bedrooms are ensuite and are located on two floors, served by a passenger lift. At the time of the inspection visit 48 people were receiving care and support at the home.

Laurel Bank is a 'care 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.

At the time of the inspection visit there was no registered manager in place. The registered manager had de-registered with the Care Quality Commission in November 2017. 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 provider had nominated a member of staff to undertake the role of acting general manager in the absence of the registered manager.

Laurel Bank was last inspected April 2016 and was overall rated as good. At this inspection visit carried out in April 2018, we found the registered provider was not meeting the required standards.

People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, processes were not always followed to ensure safeguarding concerns were consistently reported to the local authority safeguarding team for review. This meant systems to ensure people were safe from abuse were not consistently followed. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safeguarding service users from abuse and improper treatment).

We found staffing levels and deployment of staffing was not always effective to ensure the safe care of people. People and relatives told us they frequently had to wait for staff to attend to their needs.. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We looked at records maintained by the service. We noted records were not always fully complete and up to date. For example, accident and incident reports did not always include completed body maps to show injuries sustained.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

During the inspection visit we reviewed the auditing systems established and operated by the registered provider. We found auditing systems were sometimes ineffective and had not always identified concerns we identified during the inspection process. For example, a monthly audit had failed to identify a safeguarding incident had occurred and had not been responded to appropriately. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

There was lack of oversight at the home to ensure regulatory responsibilities were met. During the inspection visit we identified five incidents which the CQC had not been told of. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009.

Recruitment processes for ensuring staff were suitably qualified to work with people who may be vulnerable were not consistently applied. We have made a recommendation about this.

Arrangements were in place for managing and administering medicines. However these were not always consistently carried out to ensure good practice guidelines were followed. We have made a recommendation about this.

Risk was not consistently managed by the registered provider. We saw risk assessments were in place; however these were not always fully completed or reviewed within the stated timescales. We have made a recommendation about this.

The registered provider had a complaints process which people and relatives were aware of. People and relatives who had complained were happy with the ways in which the complaints were managed by the registered provider. Although a complaints process was implemented, we found not all complaints had been recorded within the complaints log. We have made a recommendation about this.

Staff we spoke with were aware of the principles should someone require being deprived of their liberty. Whilst good practice guidelines were sometimes considered these were not consistently implemented to ensure all principles of the Mental Capacity Act (MCA) 2005, were lawfully respected. We have made a recommendation about this.

Individuals care plans were sometimes reviewed to accommodate peoples changing needs. Care plans did not always have all the appropriate person centred information in them.

People were supported to have maximum choice and control of their lives in relation to the Mental Capacity Act and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People and relatives told us relationships with staff were sometimes limited and said person centred care was not consistently provided due to staff not having time to respond to people’s needs.

People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought from health professionals when appropriate. We saw evidence of partnership working with multi-disciplinary professionals to improve health outcomes for people.

Staff told us they were happy with the training provided. We saw evidence the acting general manager had identified additional training needs for the registered nurses and had taken action to develop their clinical skills.

Consideration had been taken to ensure infection prevention and control processes at the home were consistent.

End of life care had been discussed when appropriate with people and their relatives. Provisions were in place to promote a dignified and pain free death.

Feedback was routinely sought. We saw feedback had been received through residents meetings and formal questionnaires.

People were happy with the variety, quality and choice of meals available to them. People’s nutritional needs were addressed and monitored.

Improvements had been made to ensure activities were person centred, innovative and creative. We observed people being offered opportunities to carry out activities during the inspection visit. Activities were well received by people.

Premises and equipment were appropriately maintained. There was ongoing commitment by the registered provider to make the home pleasing for people.

Staff told us morale at the home and communication had improved since the new acting manager had been recruited. They told us improvements were being made to promote safe and effective care and said they had confidence in the acting general manager.

This is the first time the service has been rated as Requires Improvement.

You can see what action we told the provider to take at the back of the full version of the report.

Laurel Bank is a purpose built nursing home situated close to the city centre of Lancaster. At the time of our inspection visit there were 56 people who lived at the home. People who live at Laurel Bank are older people, younger adults and may have a physical disability. All bedrooms are en suite and are located on two units, served by a passenger lift. There are two double rooms available for those who wish to share facilities. Amenities are within easy reach, such as shops, pubs, library, cafes, museums, leisure facilities and public transport links.

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.

At the last inspection on 05 November 2013, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, staff responsible for assisting people with their medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and appropriate arrangements for storing medicines were in place.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure. One person told us, “I am quite safe with the staff, they are very good.”

The provider had recruitment and selection procedures in place to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Comments we received demonstrated people were satisfied with the care they received. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care.

A complaints procedure was available and people we spoke with said they knew how to complain. Staff spoken with felt the registered manager was accessible, supportive and approachable and would listen and act on concerns raised.

The registered manager had sought feedback from people who lived at the home and staff. They had formally consulted with people they supported and their relatives for input on how the service could continually improve. The registered manager had regularly completed a range of audits to maintain people’s safety and welfare.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service.

There appeared to be a friendly and welcoming atmosphere within the home. One person told us, 'You don't have to get up if you do not want to, like some places. They will bring my meal and stay with me to make sure I do not choke. You have got your own freedom.' A second person told us, 'It is much better than my last place, I could not get out of quick enough. My personal care is dignified and respectful.'

One relative we spoke with told us they were happy with the care and support provided, 'If it`s a nice day and we want to go out they give us blankets, nothing is too much trouble. You never feel if you ask for something there is any hesitation.' A second relative told us, 'We looked at three places; this one had good reports from friends.'

Our discussions with staff confirmed they were aware of their responsibilities and what actions to take if they suspected someone was at risk of harm or abuse. People we spoke with told us they felt safe.

We looked at the staffing rotas over a four week period and they showed us there was sufficient staff on duty with a range of skills and experience to meet the needs of the people who lived at the home. Staff were supported with training and personal development.

There were a range of audits and systems in place to monitor the quality of the service being provided.

'Of course we can do what we want it's our home isn't it?'

'I have a lot of good friends here and we help each other'.

'When they come to get you up they ask you if you would like a bit of a lie in and then come back when you want to get up'.

'They encourage you to be self reliant but they will still do anything for you if you ask'.