The Laurels and The Limes Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

A new online care planning system had been introduced and staff assessed people’s needs using a range of risk assessment and health assessment tools. People’s communication needs were also explored and staff understood people’s different communication methods. However, we could not be assured these records were up to date as many of them were overdue a review. We found some conflicting information in relation to people’s nutritional needs and some gaps in daily records. People and relatives were involved in their care planning and understood how to access their care records. Some external professionals told us communication was not good from the service and some relatives told us they were not kept informed. Some people told us they had to wait for personal care to be carried out and we observed this during our assessment. People were complimentary about the meals provided and people had access to snacks and drinks throughout the day. People and relatives were encouraged to give feedback about their care.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they had care plans in place and could access these if they wished to do so. Peoples individual communication needs were explored and staff used different methods of communication depending on people's needs, such as a talking mats. Most people told us they were happy with their care and support. 'Resident of the day' had been introduced and involved people and their relative in their care reviews. A person said, "I am happy with the care here." A relative said, "[Relative's] care plan is discussed in meetings, I am happy with the care."

Staff had access to care records via handheld devices and staff could record daily support provided to people. Staff did not tell us of any concerns relating to care plans or assessing people's needs. Staff told us they understood people's communication needs, one staff said, "We know how people communicate because we know them well."

A new online system had been introduced which recorded people's care records and assessed needs, including people's health, nutritional and emotional well being needs. Staff used a range of risk assessments and health assessments tools on this system to assess people's needs and wishes. However, we could not be assured these were up to date, we found some conflicting information in records and various records which were overdue a review.

There was a lack of dementia friendly signage around the communal areas and on bedroom doors, which would help people living with dementia orientate themselves around the service. Records did not evidence staff always followed guidance given by external professionals, such as Speech And Language Therapy (SALT) guidance relating to nutritional needs and district nurse guidance in relation to repositioning. Most people and relatives told us they were involve with their care planning.

We received negative feedback from external professionals re communication with the service. A professional told us they had had to request documentation on multiple occasions. Another professional told us staff did not always act upon their advice. However we were told communication books had been introduced and communication was improving.

Improvements were required to ensure staff were accurately completing daily records, to evidence care and support was provided in line with peoples assessed needs.

Most people were happy with the staff team. One person said, "The staff work hard, they are always kind."

Staff told us they had developed good relationships within the team and with external professionals. One staff said, "We have nurses coming in, we have great relationships, we have chiropodist and they will do people's nails." Staff told us morale was good within the team.

The local authority had concerns about the safety and quality of the care people received. We received negative feedback from external professionals re communication with the service. A professional told us they had had to request documentation on multiple occasions. Another professional told us staff did not always act upon their advice. However we were told communication books had been introduced and communication was improving.

Improvements were needed to ensure staff recorded effectively and evidenced they followed guidance and advice given by external professionals. Communication between the service and external services required improvement to ensure people received a continuity of care. Online care planning systems meant information could be shared quickly and easily between services as required.

People received support from a range of external professionals. Weekly GP ward rounds were in place, and people received support from chiropodists, nurses and Hospice's. We received mixed feedback from people and relatives regarding people's access to external professionals. 1 relative said they had been told their loved one required physiotherapy, but this had not been put in place, whilst another said staff always consult the GP if required. People were offered various meal choices and several drinks rounds were observed. Jugs of fluids were available in communal areas and bedrooms. Feedback re meals was overall positive. Comments included, "There is plenty of food" and, "The best thing here is the food." We observed a range of meal choices for people to choose from, second portions being offered and tables were set for people. Where people required assistance with feeding, such as via a tube, this was done so safely.

The manager told us they held multi disciplinary team meetings and care reviews to discuss and monitor people's health needs. Staff told us people had a choice of meals and drinks.

Records did not always evidence people had received nutrition and fluids in line with their assessed needs. For example, where people required fluid monitoring, daily logs did not always evidence enough fluids were offered.

Staff did not always promote good outcomes for people. Some people told us they had to wait for personal care or do it themselves, we observed some people looking unkempt. We observed a person waiting a long time to be cleaned up after lunch. Some relatives told us their loved ones had had to wait for personal care to be carried out. One person said, "I have to ask for a shower or I have to do it myself." A relative said, "[Name] was left for several hours dirty and we had to ask the staff to come to do personal care." Whilst other people said, "I have a bath when I want." And a relative said, "Staff are always cleaning [name] and keep them clean and tidy."

The leadership team told us they were committed to listening to people and improving outcomes for people. They also told us feedback they received from people and relatives was overall positive.

Records required strengthening to ensure peoples care and treatment could be effectively monitored. Communication process required improving to ensure people and their relatives were kept informed. We received mixed feedback from relatives regarding communication from the service, some said they were kept informed, whilst others said they hadn't been informed about infection outbreaks and 1 relative told us they hadn't been informed regarding a fall. People and relatives meetings were held, people were encouraged to give reviews of the service and follow the homes social media page, where key events and information could be shared. Feedback was sought from people and relatives, and used to make improvements. People were encouraged to give feedback via carehomes.co.uk and the overall service scored had improved in recent months.

People told us staff sought their consent and respected their privacy. We observed staff seeking consent from people with most day to day care and support, for example during moving and handling.

Staff were aware of how to seek consent from people and told us how they promoted people's independence and choices. One staff said, "We take a gentle approach to gaining consent, if anyone refused care we would report this and document it." Another staff explained how they seek consent from one person using gestures and writing.

Whilst consent was sought from people for care and support, consent was not sought from people regarding lack of access to their bedroom areas in The Laurels building. This is a blanket restriction and no DoLS authorisations had been sought regarding this.