The Laurels and The Limes Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider did not have effective systems in place to manage risks posed to people. This was a breach of regulation 12 of the HSCA 2008 (Regulated Activities) Regulations 2014. Improvements were required about how the service learned from accidents and incidents. Most people told us they felt safe living at the service and action was taken to safeguard people from the risk of abuse. The service did not always ensure they were working in line with the principles of the Mental Capacity Act and some people were being deprived of their liberty without the necessary authorisations being in place. Staff were suitably trained and recruited safely. Whilst dependency tools used by the service showed enough staff were provided, staff were not always suitably deployed. Most people, relatives, staff, and external professionals told us more staff were needed. Improvements were required to ensure the environment was safe and to ensure people were protected from the risk of infections. Medicines were safely managed and people received their medicines as prescribed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were supported by staff who knew them well, most people and relatives told us they could approach staff with any concerns they had about their safety. A relative said, “I feel [relative] is extra safe here because when I come, they know all about their needs.” Where people had accidents and incidents, action was taken to ensure people received the appropriate support, such as seeking medical attention and referrals to appropriate external professionals.

Staff understood their roles and responsibilities to report and record incidents. Leadership teams shared lessons learned with staff through supervisions and staff meetings. However, action was not always taken by the leadership team when themes had been identified.

Accidents and incidents were recorded, reviewed and monitored. Themes and trends were identified, however action was not always taken when themes had been identified. For example, where there had been an increase in falls in The Laurels area, it could not be evidenced what action was taken to address this.

Pre admission assessments were in place and staff gathered information about people's needs prior to them receiving support. A relative said, "[Relative] has come here for respite care for a few weeks, everything has been fine and I have no worries."

Staff and leaders told us how they support people between services. Leaders communicated with transfer teams to ensure people moved between services safely.

We did not receive any negative feedback from partners regarding this quality statement.

A new online care planning system had been introduced, which improved how information was shared between services. Hospital packs were available which included key information about people should they require a stay in hospital.

Most people told us they felt safe living at the service. One person said, "I want to stay here, I feel safe here." A relative said, "[Name] is without doubt in the best place, I am glad we have a place here." People were protected from the risk of abuse.

Staff were trained in the use of equipment and understood their roles in relation to managing risks posed to people. Staff told us they had access to people's risk assessments via the online system. A staff said, "I have had all my training in the use of the equipment, we look at people's risk assessments on the system, I know people's needs." However, we found concerns people’s risk of were not being managed appropriately. The provider had not always ensured there was up to date guidance for staff to follow or ensured staff were always completing records related to the management of people’s risks appropriately.

We observed kind interactions between people. However the service did not always adhere to the principles of the Mental Capacity Act. We observed people in The Laurels area which had all been moved in the morning to a downstairs area. This is covered under the Caring key question.

The provider was placing unlawful restrictions on people’s liberty. The provider had not completed the necessary process to restrict people’s access to their rooms in The Laurels area during the day. No Deprivation of Liberty Safeguards (DoLS) applications, capacity assessments or consent was sought from people regarding this. We also found another service user who had not had the necessary DoLS application submitted in regards to their care and treatment. Policies and systems were in place to safeguard people from the risk of abuse. Safeguarding incidents were recorded and monitored. Notifiable incidents were reported to external agencies as required, such as CQC and the Local Authority.

Risks posed to people were not always safely managed. Most people felt safe living at the service, however 1 person told us staff left them to mobilise alone if they were busy. We found daily records which showed 1 person had been given food which was not in line with their assessed needs. This was brought to the attention of the leadership team and action was taken to address this.

Staff were trained in the use of equipment and understood their roles in relation to managing risks posed to people. Staff told us they had access to people's risk assessments via the online system. A member of staff said, "I have had all my training in the use of the equipment, we look at people's risk assessments on the system, I know people's needs."

During our site visit we observed some practice which did not always promote people's safety. This was observed in The Laurels area of the service. We observed an open store which contained COSHH products, placing people at risk of ingesting unsafe substances. This was brought to the attention of the staff during the visit and immediately rectified. We observed 1 person being hoisted using a generic sling, which placed them at risk of unsafe moving and handling. We observed another person who had not had their legs elevated in line with with their assessed needs, to reduce their Oedema. Staff took action when this was brought to their attention by the inspector.

We could not be assured the processes in place always managed people's risks and provided staff with up to date guidance. Whilst people's risks were assessed, several records were overdue a review. We found conflicting information between kitchen and care plan records relating to people's nutritional needs. Where people required pressure area care it could not be evidenced they were repositioned as required, we found gaps in daily records and care plans did not indicate what settings air flow mattresses should be set at. This was found to be a recording concern and is covered in the well led section of this report.

Improvements were required to ensure the environment was always safe. Some people told us the equipment and environment was safe, however some relatives told us they had to wait for equipment to be provided. A relative said, "We had had to wait over 2 weeks when [relative's] bed was broken" and another relative told us they had to wait 2 weeks for a sensor mat to be provided, during which time their relative had a fall.

Most staff told us they felt the environment and equipment was safe for people. However a staff told us they did not have enough time to maintain the 2 buildings across the site. This was evidenced through our observations and processes. The senior leadership team were open and honest and told inspectors they recognised this as an issue, however this required actioning, to ensure the environment promoted people's safety.

We observed some environmental hazards during our site visit, such as fire doors wedged open and broken door handles. We observed some trip hazards such as trailing wires from floor mats and a lifted foot plate. This was brought to the attention of the management team and some action was taken to address these concerns. The providers internal observations relating to environmental safety had not always identified or rectified environmental safety concerns.

Systems and processes in place did not always ensure the environment was safe for people. Internal audits did not identify concerns found during the inspection. The service used external contractors to undertake environmental safety checks and risk assessments, such as fire safety, legionnaires management and lifting equipment checks. However, various internal ongoing maintenance checks, including checks of fire safety equipment and legionnaires safety checks had not regularly been undertaken. The maintenance team had recently been expanded and improvements were being made to environmental safety checks and maintenance of the site, however this required embedding into practice at the time of our inspection.

Improvements were required to ensure staff were deployed effectively to meet people's needs in a timely way. Dependency assessments were used to calculate staff required in each building and rota's showed the correct amount of staff were provided. However, some people, relatives, and partners told us more staff were needed. One person said, "There is never enough staff." A relative said, "When we press the call bell, you can be waiting 5-10 minutes." A visiting professional said, "There's not always enough [staff] around the service." Most people and relatives told us staff were kind, competent and trained to carry out their roles. A relative said, "The staff are exceptional."

Staff told us they were trained and felt competent, supported and confident in their roles. We received mixed feedback regarding staff numbers. Some staff told us they were often rushed and the service would benefit from increased staffing in areas. One staff said, "If things change, we don't get more staff, we are more thinly spread." Whilst another staff said, "We do have enough staff, it can at times be rushed but we do have enough."

We observed several call bell alarms to be activated for long periods, staff did not always answer these or check what had activated them in a timely manner. No staff were allocated to The Laurels area upper floor during the day and we observed a person having to wait until staff were available to access their bedroom.

Staff were recruited safely and all pre employment checks were in place. Staff were suitably trained and had their competency assessed in a range of areas, such as infection control practices, and handwashing. Staff received regular supervisions and appraisals where they could raise concerns and make suggestions. The service used agency staff to cover shortfalls and where agency staff were used they received an induction to the service.

We received positive feedback from people and relatives regarding the cleanliness of the service. Comments included, "The home is clean", "Staff wear gloves and aprons" and, "I have no complaints, it is clean and tidy."

Staff were trained and understood their roles and responsibilities regarding safe infection control practices. One staff said, "We use masks, gloves and aprons and we wash our hands after (personal care tasks)." Some staff told us there was not enough domestic staff to cover the site effectively. This was evident in our observations and assessment of processes.

Improvements were required to ensure the service promoted safe infection, prevention and control practices. Some areas of the service, particularly in The Laurels area had a malodour. We observed stained beds and chairs, rotted window frames and stained bathroom flooring. Personal Protective Equipment (PPE) was not always stored correctly. Areas of exposed wood was observed to several handrails, doors and door frames, meaning these could not be cleaned effectively. Some pedal bins were broken and a yellow clinical waste bin was found to be overflowing. Hairbrushes were stored in a communal cupboard and kitchen areas in both buildings were visibly dirty.

Systems and processes in place were not always effective in identifying concerns found during our assessment. Where infection outbreaks had occurred, this was reported to external agencies as required. Staff had access to up to date policies and guidance about how to keep people safe from the risk of infections. Staff wore appropriate clothing to minimise the risk of the spread of infection.

People received their medicines as prescribed. Records contained people's information, including any allergies and preferences about how they like to take their medicines. A relative said, "Staff do all the medication and it is given on time." Another relative said, "We have had meetings and discussed [relative's] needs and medications."

Staff were trained and had their competency assessed prior to administering medicines to people. Staff did not raise any concerns regarding medicines management. One staff said, "Senior and clinical staff oversee staff's medicines competencies."

Medicines were safely managed. People's Medicines Administration Records (MAR's) were complete and medicines were correctly stored and disposed of. Controlled drugs were managed safely and regular stock checks were undertaken of all medicines. Regular audits were undertaken to ensure people received their medicines as prescribed. Sharps were safely stored and disposed of.