Laureston House Residential Home

¿ The risk of infection from visitors was minimised. Visiting was by appointment only. There was a visitor pod in the vestibule so relatives could safely visit their family members. Visitors were able to access the pod without entering the service.

¿ Arrangements had been made for a relative who was an essential care giver to safely contribute to caring for their family member.

¿ There was a video portal enabling people living in the service to see and speak with their family members. Relatives also received a regular newsletter from the registered manager. These provided updates about developments in the service particularly relating to keeping people safe from Covid-19.

¿ New people were able to safely move into the service. A negative test for Covid-19 and a 14-day isolation period were in place. Health monitoring was in place both during the isolation period and afterwards to make sure people remained free from symptoms of infection.

¿ Adaptations had been made to the accommodation to support infection control. Safe routes to bedrooms had been identified to enable relatives in future to visit their family members while minimising the need to walk through the service to promote social distancing.

¿ The registered manager knew what government guidance said about managing risks associated with Covid-19. There were up-to-date infection control policies including those specific to Covid-19 and infection outbreaks.

¿ There was enough personal protective equipment for staff and visitors and this was being used in the right way.

¿ There were cleaning schedules in place. The service was neat and clean. Regular infection control audits were done by the infection control lead with actions followed up when necessary.

¿ People living in the service had consultations with their with doctors when necessary and the service received advice from specialist infection control nurses.

Further information is in the detailed findings below.

Laureston House Residential Home is a residential care home providing personal care to 20 older people, some of whom lived with dementia, at the time of the inspection. The service can support up to 21 people. Accommodation is provided in one adapted building across three floors.

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

Feedback from people, relatives and a health and social care professional was consistently positive about the service and staff. People told us they were happy with the care they received, and said staff were kind and caring. One relative wrote to the service and said they were really impressed with the atmosphere at the home and it was ‘quite like home from home.’

Care plans had been re-designed and there was now clear information for staff to enable them to support people safely. Medicines management had improved and was now well managed. Health care professionals were positive about the safety of the home and the management of medicines.

Risks to people from the environment were managed. Where incidents or accidents had occurred, they had been recorded and acted upon appropriately.

There were enough staff to keep people safe and people’s requests for support were responded to quickly.

Staff had been recruited safely and had the skills, training and knowledge they needed to keep people safe. Staff understood how to protect people from the risk of abuse and ensure people’s rights were protected. 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.

The service had been re-decorated where needed. There were new carpets in place and the service was free from odour. New storage had been arranged and the service was free from clutter.

People’s needs had been assessed and assessments had been used to plan people’s care. This included ensuring equality and diversity needs were met and communication needs. End of life care was discussed with people and their wishes and preferences were recorded. People were involved in planning their own care and their preferences and choices were respected.

People were happy with the food and drink at the service. Where people were at risk from dehydration, malnutrition or choking whilst eating staff provided the support people needed to remain safe. There was an activity coordinator and activities were varied. The service was lively, and people enjoyed the activities which were offered.

Staff worked well with other agencies and supported people to access healthcare services where needed such as GP’s, dieticians and dentists.

There was a complaints system in place. People had opportunities to feedback about the service through written surveys and residents and relatives’ meetings.

There was a positive atmosphere at the service. Staff were well supported and supervised appropriately. Checks of the service quality were undertaken and issues were acted upon where identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 25 December 2018). There were breaches of regulation relating to safe care, governance and person-centred care.

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Since the last inspection we recognised that the provider had failed to display their rating on their website. This was a breach of regulation a fixed penalty notice. The provider paid this in full and the rating is now on display.

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.

Laureston House Residential Home 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. The service is registered to accommodate up to 21 people. At the time of the inspection there were 18 people living there, some people were living with dementia.

At the last inspection the service was rated good. At this inspection we found that the provider had been unable to sustain this rating. The service is now rated requires improvement as we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.

There was a registered manager at the service who was supported by an assistant 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 2008 and associated Regulations about how the service is run.

Risks to people were not always mitigated. This included risks associated with skin integrity and continence needs. Where people needed equipment to remain safe this was not always being used. The service was not able to demonstrate that risks from the environment had been managed. For example, the service was not able to demonstrate that the lift had been checked to ensure that it was safe before the inspection.

Medicines were not always managed safely. For example, creams and liquids were not dated when they were opened so staff would not know when they needed to be used by. Medicines were not always stored safely.

The environment did not always meet people’s needs. The decoration in of the home needed to be improved in some areas. Some areas needed some repair and there was a lack of storage which meant that some items were stored in areas used by people. One toilet door opened towards the wall and this made it difficult for people to access this room. We made a recommendation about the environment.

Care was not always person centred. There was a risk that people were socially isolated and lacking stimulation. The registered manager had organised some activities and outings but there was no activities coordinator in place and access to meaningful activities was limited. Some people spent a lot of time in their room and the service was not able to demonstrate that people were provided with social interaction. Some people told us that they were bored, and one person said that they got lonely sometimes. People had end of life care plans in place, but these had not been completed meaning that their preferences had not been recorded.

The registered manager did not always have oversight on the quality of the service. Checks on the quality of the service were not always undertaken regularly. Care plans had only been audited once. Daily contact sheets were not audited. Staff had regular supervision and appraisals and told us that they felt supported. However, medicine competency checks were not recorded. There were no checks to ensure that people were undertaking manual handling safely. There were no checks to ensure that staff that worked when the registered manager was not usually there were following safe practice. Lessons were not always learnt when things when wrong. Some incidents were not recorded so could not be analysed for trends. Following some concerns raised by a whistle-blower the local authority had made recommendations about how the service could be improved. These recommendations had not always been actioned.

People were protected from abuse. However, some staff were not able to tell us how to identify and report abuse. Staff were not always able to demonstrate people’s rights when they had capacity to leave the service. Staff were not always complimentary about the standard of the training offered. We made a recommendation about staff training. New staff completed an induction before they started work at the service. Robust recruitment processes ensured that staff were suitable to work with people before they started.

Staff understood the principles of the Mental Capacity Act. However, there was no recorded best interest decisions to demonstrate how decisions for people had been taken in their best interests.

People were protected from the risk of infection. However, the service was not following best practice guidelines to protect people from the risk of waterborne infections. We made a recommendation about this.

There was enough staff to keep people safe. However, there was a concern that there was not enough staff to support people to engage in regular meaningful activities.

When people moved to the service their needs were assessed to ensure that the service was able to provide them with the support they needed. When people’s needs changed their care plan was updated.

People were offered a choice of drinks and food. People had access to snacks between meal times if they wanted them. People had access to healthcare professionals when they needed this support. Where people were at risk of losing weight or at risk of choking they had been referred to a relevant health professional and there was guidance in place for staff to follow to support the person. When people went to hospital there was information for them to take with them so that hospital staff were aware of their needs.

People were treated with kindness and compassion. Their dignity and privacy was respected. People had the opportunity to feedback about their care and express their views through reviews of their care plan, resident’s meetings and regular surveys. There was a complaints policy in place and people knew how to complain if they chose to do so.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Laureston House Residential Home is a large detached house in a quiet residential area, close to Dover castle and town centre. It provides care and support for up to 21 older people some of whom are living with dementia. There were 20 people living at the service when we visited.

There was a registered manager employed at the service. The registered manager was planning to retire from the service in early 2017, so the deputy manager had been promoted to a manager role in preparation to take over from them. 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 in October 2015 we found breaches of regulations. At this inspection improvements had been made.

At the last inspection there had been a breach of regulations relating to testing water temperatures and testing for legionella. Improvements had been made and testing was now happening on a regular basis.

At the last inspection there had been a breach of regulations related to the management of medicines. People were being left with their medicines rather than staff observing that the medicine had been taken, people were being given ‘as and when required’ medicines on a regular basis and records were not being completed properly. The temperatures at which medicines were being stored was not being monitored, (if medicines are stored outside the recommended range of temperature it can affect how well they work.) Staff had changed the times of a medicine without any instruction from the doctor to do so and there had been an error in the number of doses of medicines stored.

At this inspection improvements had been made and medicines were managed safely and people were encouraged to be involved in taking their medicines. Staff stayed with people until they had taken the medicine and asked people if they would like ‘as and when required’ medicines before giving them. Temperatures were monitored and administration records were completed immediately after the person had taken their medicines. Medicine record sheets had not been altered by staff and there were the correct number of doses being stored.

At the last inspection there was a breach of regulations related to auditing the service and not identifying issues and not sharing the results of a quality audit survey. At this inspection improvements had been made. The management team had developed a new auditing system which they had completed regularly. This identified issues and showed the actions the managers had taken to resolve them. Results of quality assurance audits were now being shared.

At the last inspection there was a breach of regulations related to risk assessing how to safely move people. The risks associated with using bed rails had not always been assessed to ensure that bed rails were safe to use. At this inspection improvements had been made.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests, however some of the mental capacity assessments needed updating in case people’s capacity had changed. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS authorisations in line with the legislation.

People had care plans to identify their needs and how they preferred to be supported. Some of the care plans needed updating or would benefit from more detail. There were activities provided for people, but information about these was not displayed in an accessible way. People told us they sometimes got bored; the registered manager agreed this was an area they could develop.

People told us they felt safe. Staff knew how to keep people safe and who to talk to if they had any concerns. Risks to people were assessed and there were plans in place to minimise the impact of risks on people, some of these plans needed to be updated so staff had the most up to date guidance.

The management team completed audits to identify environmental risks. Fire drills were completed and people had a personal emergency evacuation plan (PEEP) in case of a fire.

Staff had been recruited safely, and there were enough staff to meet people’s needs. Staff who were new to the service had an induction which included training and a chance to get to know people. Staff continued to have training in both core subjects such as safeguarding and first aid, along with training related to the needs of the people they supported.

Staff had regular one to one meetings with the management team, annual appraisals and team meetings. Staff told us they felt supported and valued. Staff said they could approach the management team about anything.

People and staff knew each other well and seemed very comfortable in each other’s company. Staff adapted their way of working for each person, and treated people with dignity and respect. Family members and visitors said they always felt welcomed at the service. People were involved in planning their care and were encouraged to express their views about the support they received. Staff gave people time and supported people to be as independent as they could be.

People and visitors told us that the food was good; the cook had a good knowledge of what people liked and disliked. People were encouraged to eat and drink enough to maintain good health. Staff worked closely with health professionals and advice about people’s health needs was sought when needed.

People told us they knew who to speak to if they had a complaint. The management team sought feedback from people, their relatives and visitors. Feedback was generally positive; any negative comments had been addressed and learned from.

People, staff and relatives told us that the management team were approachable and resolved any issues quickly. Staff said they felt supported by the managers. The managers had attended local forums to learn about good practice and had shared this information with the staff team through meetings.