Laurel Villas provides accommodation for up to 24 adults, who require help with their personal care needs. The home is situated in a suburban area of Ashton in central Preston and is close to shops and local amenities. Laurel Villas is arranged over two floors with passenger lift access provided to the upper floor. En-suite facilities are available in many of the rooms. The home offers short tolong term care or a home for life. On road parking is available outside the home.
The last inspection of this service took place on 11 November 2014. At the last inspection the service was rated Good.
The registered manager was present throughout our inspection visit. 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.
This unannounced inspection was conducted on 10 August 2017. At this inspection we identified some concerns and breaches of regulations.
We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act 2005 (MCA). We found the principles of the MCA were not consistently embedded in practice. Written consent to various aspects of care and treatment was observed on some people's files. However, in others, consent forms had not been completed. We also found some examples where consent had been provided by people's family members, but there was no confirmation the people who had provided consent had legal authority to do so.
Evidence was available to demonstrate staff had submitted an authorisation for the Deprivation of Liberty Safeguards (DoLS) application for one person who used the service. However we found multiple examples of restrictive practices contained within the care files. These included the use of door monitors and sensor mats to alert staff to when people were out of bed. In addition we observed the front door was locked with a keypad and people were not always free to leave the building as they wished.
The concerns amounted to a breach of regulation 11 (Consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We have made a recommendation about infection control.
We have made a recommendation about quality and monitoring checks.
When we last inspected this service in November 2014 we made some recommendations to the provider. We checked on this inspection if improvements had been made. During our last inspection, we made a recommendation around medicines audits. At this inspection we checked the audit for medicines and found the provider had implemented a comprehensive medicines audit since our last inspection.
During our last inspection, we made a recommendation around accidents. This was due to the documentation not being retained in a confidential manner. We looked at how accidents and incidents were being managed during this inspection. We found there was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these.
During our last inspection, we made a recommendation around the induction process for staff. We looked at this process during the inspection and found changes had been made. We spoke to staff members who had recently started working at the service. One staff member told us, “I have had lots of training and support; I completed shadow shifts and did not begin working on my own until I was confident.”
During our last inspection, we made a recommendation around peoples dietary needs being recorded into their care plans. We looked at peoples care records during this inspection and found the service was pro-active in supporting people to have sufficient nutrition and hydration.
During our last inspection we made a recommendation around involving people and their relatives in the care planning process. We checked improvements had been made at this inspection. The management team and staff told us they fully involved people and their families in their care planning. People told us they were aware of their care plan and felt able to input to it if they wished One relative told us, “I’ve been involved in the care plan from the beginning.”
At this inspection people who lived at Laurel Villas told us they felt safe and supported by staff and the management team. Systems were used to reduce people being at risk of harm and potential abuse. Staff had received up to date safeguarding training and understood the provider's safeguarding adult’s procedures. People told us there was enough staff on duty and staff came quickly to any requests for support. One person told us, “There are definitely enough staff.”
We looked at how risks to people were being managed; we found people were protected from risks associated with their care because the registered provider had completed risk assessments.
People were protected by suitable procedures for the recruitment of staff. Maintenance records showed safety checks and servicing in the home including the emergency equipment, water temperatures, fire alarm, call bells and electrical systems testing.
People received care which was relevant to their needs and effective because they were supported by an established staff team. They also had received appropriate training such as moving and handling and had a good understanding of people’s needs. We confirmed this by our observations during the day.
We observed lunch being served, people ate in a relaxed manner and they enjoyed their meals. People had a choice of what they wanted to eat and staff were aware of people’s needs in this area. People told us, “I’ve had a lovely dinner.” Also, “The food is very good.”
Care plans showed where appropriate the service had made referrals to health care professionals such as the community nursing team and GP's.
We received consistent positive feedback about care provided at Laurel Villas from people who lived at the home. People's beliefs, likes and wishes were explored within care records and guidance in these records reflected what staff and people told us about their preferences.
We saw care records were written in a person centred way and observed staff followed guidance in care records. We found assessments were undertaken by management prior to any person being accepted into the home. Assessments took place to ensure people’s needs could be met by the service.
We saw people engaged in activities positively with staff. People were supported and encouraged to take part in activities, these were provided by the care staff and included one to one time and games. During the afternoon of the inspection visit there was a group of people being supported by staff to play dominoes in the garden.
People were encouraged to raise any concerns or complaints. The service had a complaints procedure and we saw evidence this was followed.
People who lived at the home and relatives told us the home was well led. We found the registered manager to be familiar with people who used the service and their needs.
We found minutes of meetings were retained and staff confirmed they had meetings, so they could get together and discuss any relevant topics in an open forum.
We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.
You can see what action we told the provider to take at the back of the full version of the report.