The Laurels Care Centre

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

Quality systems were being further established and embedded into daily practice to support quality care and record keeping in all areas. Whilst we identified some areas in record keeping for improvement this had already been identified by the manager and an action plan had been developed and risk therefore was mitigated.

Staffing arrangements were safe and ensured people’s needs were met in a timely way. Staff had received training and regular updates on safeguarding people. They understood how to respond to any suspicion or allegation of abuse or discrimination. Staff were recruited safely. People's medicines were handled safely. There were suitable arrangements in place to assess and respond to any risk to people. The service was clean and well maintained. New flooring and redecoration was in progress.

Visitors were welcomed at the home. People were able to receive visits from their named visitors. Some people received visits from relatives who were essential care givers. Essential care givers are relatives or friends who are able to spend more time with the person to help meet their physical and emotional needs. Visiting took place in a lounge which had been converted to a visiting room with a room divider. Dependant on people’s needs, some visits took place in the person’s room. Garden visits were also available. Throughout the pandemic, where people were receiving support with end of life care, they had been able to receive regular visits from family in their bedrooms. Visiting was on an appointment system to allow time for appropriate cleaning between visits and keep the home safe from the risk of infection. All visitors were required to have a rapid Covid-19 test before the visit. During the visit they wore the appropriate personal protective equipment (PPE).

The registered manager knew people and staff well and promoted an open culture where people and staff felt they could share their views. They understood their responsibilities and were passionate and committed to delivering a high standard of care to each individual person in the service.

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 Good (published 09 August 2018). We also undertook an Infection Control Inspection (IPC) (published 05 March 2021)

Why we inspected

This inspection was prompted due to information of risk and concern. CQC received concerns in respect of staffing levels, which had impacted on care delivery and lack of leadership. The concerns raised were looked at during this inspection and have been reflected in the report.

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.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We found the following examples of good practice

The home was currently following government guidance and was closed to all visitors apart from those who loved ones were on a palliative care pathway and receiving end of life care. Visitors at this time were asked to wear personal protective equipment (PPE), have a lateral flow test on arrival and have their temperature taken. This included health professionals. There was a visiting policy to support visitors once the home re-opens to visitors. There was also a visiting room with an outside entrance where families will be able to meet their loved ones' safely.

The home has just re-opened for admissions. All new arrivals to the home will only be accepted with a negative polymerase chain reaction (PCR) test and will isolate for 14 days. There was now a dedicated isolation unit, with a separate staff team that will be used for all new arrivals for 14 days, before moving into the room of their choice within the premises.

There were systems in place to ensure that people who had tested positive for Covid-19 and self-isolating were cared for in their bedrooms to minimise the risk of spreading the virus. Staff were provided with adequate supplies of personal protective equipment (PPE) and staff were seen to be wearing this appropriately. Staff had received specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.

The home was clean and well maintained. There was regular cleaning throughout the day, and this included high-touch areas. The housekeeping staff were knowledgeable regarding current Covid-19 cleaning guidelines and robust cleaning schedules were in place. The manager was the infection lead for the home and undertook spot checks on staff practice.

Regular testing for people and staff was taking place. There had been changes to testing following their outbreak of Covid-19 as people and staff who tested positive were not tested for 90 days as per government guidance. Routinely all staff have a weekly PCR and twice weekly lateral flow test (LFT). In addition, they had their temperatures taken daily. People had a monthly PCR test with daily temperatures and oxygen level checks.

At present the majority of people chose to spend time in their rooms. Staff supported people to remain engaged with one to one activities and to remain in contact with their families through phone and video calls. People who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people. Extra staff rooms had been created and were restricted to two staff members at any one time.

The registered providers had been very supportive to their service throughout the pandemic and had ensured staff had access to counselling and well-being sessions for staff were being introduced.

Our last inspection on 10 February 2017 was a focused inspection to check the service was meeting the legal requirements following a breach from the previous comprehensive inspection on 25 and 26 November 2015. The breach was in relation to medicines not being managed safely. At the focused inspection we found improvements had been made and the provider had met the legal requirements with regards to the management of medicines; and we rated the service as good.

At this inspection we found that the service continued to support the rating of good overall and was rated good in each of the five questions we ask. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People felt safe. There were policies and systems in place to safeguard people, assess risks and manage them, and to manage people’s medicines safely. There were enough suitably recruited and trained staff to meet people’s needs. People were protected by the prevention and control of infection. Accident and incident records were closely monitored and actions were taken to ensure lessons were learnt.

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. Staff supported people to be as independent as possible. People’s needs were met, including support with eating and drinking and accessing healthcare. The provider ensured there were systems in place to ensure staff had the right training, qualifications, support and supervision to do their job.

The management team consisted of the ‘Matron’ (registered manager) and the nurses. They promoted a caring and positive culture. Staff protected people’s privacy and dignity and people were consulted, informed and involved with their care. People, relatives and staff were engaged in the service and visitors were welcomed. People could raise concerns and the provider managed complaints and feedback received from people and their relatives. People received person centred care which met their needs, were supported to engage in activities they liked and were supported well at the end of their life.

The provider had systems in place to promote continuous learning. The registered manager had good oversight of the quality and safety of the service and risks. Regulatory requirements were understood and managed.

Further information is in the detailed findings below.

The original building has recently been added to with a purpose built extension to provide a safe comfortable environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over two floors with communal areas on each floor.

The Laurels Nursing Home is owned by The Laurels Nursing Home (Hastings) Ltd and the organisation has one other care home in the South East.

At the last inspection in November 2015 we found the 'safe' question required improvement. The management of people's medicines needed to be improved to ensure that people received their prescribed medicines and care plans needed to reflect people's changing needs. We received an action plan from the provider that told us how they were to meet the breach of regulation by January 2016.

This unannounced focused inspection on the 10 February 2017 was to look specifically at the ‘safe’ question and we found that that they had now met the breach of regulation previously found.

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 and associated Regulations about how the service is run.

The registered manager was nominated in 2016 for the Great British Care Awards and was shortlisted for the regional Registered Care Home Manager Award.

People told us they felt safe living at the Laurels Nursing Home. Comments included, “Very safe and cared for,” and “Always plenty of staff to help us.” Staff told us, “We have really good staffing levels so we don’t rush and can provide safe care and treatment.

This inspection found that people were protected against the risks of unsafe medicine management. The staff were following current and relevant medicines guidance. We found that previous issues with how medicines were managed and recorded had been monitored and significantly improved.

Care plans and risk assessments were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people's changing needs. This had ensured that people received safe care and treatment.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding adults training and understood their responsibilities to report any unsafe care. Recruitment checks were carried out to ensure suitable staff were employed to work at the home and there were sufficient staff to meet people's needs. This was confirmed by talking with staff members and looking at records of staff recruitment.

We found sufficient staffing levels were in place to provide support people required. This included staff supporting people with one to one support and to attend hospital appointments. We saw staff members could undertake tasks without feeling rushed when supporting people. Staff also told us they had time to spend with people and that was promoted by the registered manager.

The home was clean and well presented. Risks associated with the cleanliness of the environment and equipment had been identified and managed effectively.

We spoke with eight people who used the service and two of their relatives. One person told us, "It is a lovely place to live."

We spoke with nine members of staff. One told us, "I really enjoy working here."

We observed staff caring for people with dignity and respect.

We looked at five care plans. We saw that they reflected the care that was being provided.

There were systems in place to identify areas of the home that required maintenance.

We looked at three staff files. The home had suitable staff recruitment procedures in place.

We saw that the home had an effective complaints procedure.

All the people we spoke with said they enjoyed living at The Laurels. One person told us 'I'm very pleased I've come here. There's a lot to do, yesterday I was down for the activities but today I think I'll just stay in my room. It's very good food too, I'm very happy here.' People told us staff treated them with dignity and respect and asked permission before carrying out personal care. The staff we spoke with were knowledgeable about people's needs and what support they required.

One relative told us 'I have 100% confidence in the staff. The care the staff have given (my relative) has directly helped her recovery. I've never witnessed staff not knocking on doors. They're always considerate.'

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The service had assurance systems in place to monitor the quality of the service provided and to gain the views of the people who lived there.