Archived: The Laurels Residential and Nursing Home

The Laurels is registered to provide accommodation, personal care and nursing care for up to 45 older people, including people living with a physical disabilities and/or dementia. The service is situated in Spondon village and is on two floors with a passenger lift for access. There is a secure garden at the rear of the premises and a patio area for most ground floor rooms.

At the time of our inspection there were 34 people using the service.

The service has a registered manager. This 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.

People and relatives told us the service was well-managed and provided a high standard of care. They said they had confidence in the registered manager who was approachable and helpful. They told us the care and nursing staff were kind, thoughtful and caring.

There was an established staff team and staff turnover was low with some staff having worked at the service for a number of years. This meant staff had the opportunity to get to know the people they supported well. All the staff we spoke with were knowledgeable about the people at the service, their personalities, and what was important to them.

People were encouraged to make choices about all aspects of their care and support including getting up and going to bed times, activities, personal care routines, and menu choices. Staff consulted with people and their relatives about how they wanted their care provided and ensured this was recorded in people’s care plans.

Staff knew how to keep people safe. They managed risk well by providing good quality and consistent care. The service was well-staffed. During our inspection visit call bells were answered promptly and if people needed support they didn’t have to wait for long. People had their medicines on time. Staff met people’s healthcare needs promptly and effectively and knew when to call in a doctor if they were concerned about a person’s well-being.

Staff were well-trained and had the skills and knowledge they needed to provide effective care. They understood the importance of obtaining people’s consent before carrying out care tasks and how to make decisions in their best interests where necessary.

People said the food served was good quality and the menu varied giving them plenty of choice. During our inspection visit we spent time in the dining room with some people who were having a late breakfast. There was a leisurely atmosphere. Staff asked people what they wanted and brought it to them promptly. A relative told us mealtimes were flexible as people preferred this.

People had the opportunity to take part in group and one-to-one activities. We saw one activity take place that involved throwing a soft ball onto a large bullseye on the floor. All those involved had turns and there were smiles and laughter as the activity progressed. At the end the tea trolley arrived and people had tea and biscuits. The atmosphere was lively and friendly and everyone present appeared to enjoy the activity and the socialising afterwards.

People and relatives also had the opportunity to comment on the service through completing surveys and attending meetings where activities, menus, and complaints were discussed and those present were asked for their views and suggestions. During the course of our inspection visit we saw the registered manager continually interacting with people and checking the quality of their care.

The regional manager, registered manager, and staff carried out quality audits to ensure the service was running effectively. Records showed they listened to people, relatives and staff and made improvements where necessary.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our inspection of 03 September 2013 we found that the provider had not ensured that all care plans and risk assessments had been completed or contained sufficient detail to meet people's needs.

At this inspection we found the care plans and risk assessments had improved. In the sample of files that we looked at we noted there was correlation between the assistance people required and the risks surrounding that care were recognised. That meant care was detailed in the plans and risks appropriately recognised.

At our last inspection visit on 03 September 2013 the provider had failed to ensure that the recruitment files had all the information required under schedule 3 of the Health and Social Care Act 2008.

At this inspection we found that staff had not completed the audits within the timescale we agreed. That was to ensure they were aware of what recruitment information was missing and then replaced the missing items.

At our last inspection visit on 03 September 2013 the provider did not have effective systems in place to prevent, detect and control the spread of health care associated infections.

We saw the provider had introduced the cleaning schedules. However these were not as detailed as we would have expected. The forms to enable an infection control audit were in place, but none had been undertaken since our last visit. That meant people were still at risk from cross contamination and cross infection in the home.

We found care plans were written in an individual way that ensured people received personalised care and support.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We were made aware of a recent application that had been submitted. Relevant staff were aware when an application should be submitted.

Medicines were stored securely. However we saw the quality assurance processes around ensuring medicines were administered and signed for appropriately were not detailed or regular enough to highlight issues.

Staff were aware of the colour coded buckets that were used in specific areas of the home. Staff told us they were provided with personal protective equipment (PPE). We also saw plentiful supplies of PPE placed around the home. That meant staff were aware when to use equipment that reduced the possibilities of cross infection or cross contamination in the home.

Staffing numbers were not sufficient to ensure people prompt care and treatment.

Is the service effective?

People's health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care.

Is the service caring?

We observed positive interactions between people using the service and staff throughout our time at the home. We heard positive exchanges between people whilst eating their lunch time meal. We were encouraged how staff positively engaged people and provided them with meaningful conversation.

Is the service responsive?

The staff took action to ensure a person who was not given the correct amount of medicines had not been harmed after we highlighted the issue during our visit.

Is the service well-led?

Quality assurance systems around infection control, medications and recruitment were not sufficient to ensure issues were recognised and corrected in a timely manner.

Most people we spoke with were happy with the care provided. Comments included: 'I wouldn't have stopped this long if I didn't like it', 'brilliant' and one relative told us 'it's had its ups and downs but on the whole its pretty good'.

We found that not all risk assessments had been completed and that action had not always been taken to reduce risk.

We found that there were concerns with the cleanliness of the building. Although the provider had infection control audits we deemed these to be ineffective as they had not picked up on concerns.

Although staff members had a criminal records check, we found that the provider had not carried out sufficient pre-employment checks on staff members to ensure that they were suitable to work with vulnerable adults.

Staff we spoke with felt that staffing levels allowed them to meet people's needs and most people who used the service that we spoke with agreed with this.

The provider had a complaints system in place. There was evidence that complaints had been investigated and action taken.

The provider undertook an investigation into the administration of medication. As a result two qualified nurses have attended additional medication training. All qualified staff have been assessed to check they were competent to administer medication safely.

A number of systems have been introduced to ensure that medication was always available, administered correctly and the records signed. Daily audits of medication records have been introduced to check for any gaps in signing, and that staff had recorded the stock balance at the beginning of each month. This meant checks were being carried out to ensure people were given their prescribed medication. The provider told us they were reviewing the procedures in place for reordering medication, to ensure prescribed medication was available at all times.

The local authority carried out a medication audit on 20 December 2012. The local authority assessed the service as having good standards, which met the minimum legal requirements.

We saw that people's capacity to make decisions about their lives was recorded in the care records. People's support, treatment and care were detailed in their individual care plan, assessments and risk assessments. We found that people were not always receiving their medication as prescribed, which may people's health was bring put at risk. This was because either medication was out of stock, or registered nurses had not give medication to people as prescribed.

Staff told us they received appropriate professional development and they felt equipped with the skills they needed to care for the people who used the service.

We saw there were systems in place to regularly assess and monitor the quality of service that people receive.