The inspection of this service took place on 6 and 7 March 2018 and 6 June 2018. The inspection was unannounced. At our last inspection of this service we found that the provider was not meeting the legal requirements and was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not always sufficient numbers of support staff to meet the assessed needs of people living in the home.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘safe’ to at least good.
At this inspection we found that there were still insufficient numbers of suitably qualified staff, appropriately deployed, in order to meet the needs of people living at The Laurels. We also found that medicines and risks were not well managed. This meant that the provider had not made the necessary improvements to the key question ‘safe’.
The Laurels is a care home but is not registered to provide nursing care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The Laurels is registered to accommodate 29 older people, some of whom may be living with dementia, in one adapted building. The home is situated in a residential area not far from the centre of Carlisle. Accommodation is found on the ground and first floor of the property, which is accessed by a passenger lift and stair lift. There is a dining room and three lounges, on the ground floor, that give communal space for people to enjoy. There is also a small garden area.
There was a registered manager for the service. 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.
We found that the service did not always manage and administer people’s medicines in a safe way. Records were not accurately maintained and we observed some unsafe practices by staff. We reviewed the ways in which the service responded to accidents and incidents. We found that risk assessments and assessments of people’s care needs were not accurately reflected, nor did they provide clear guidance for staff to follow. This meant that the service did not consistently protect people from the risks of receiving unsafe care.
The food provided at The Laurels was freshly prepared on site. People were able to choose what they would like to eat at each meal. People who needed help with eating and drinking were not always supported effectively. Where people had been identified as being at risk of poor nutrition, staff had not always robustly monitored people’s body weight or nutritional intake. This meant that accurate information could not be passed on to the doctor or dietician if needed. The provider did not have adapted cutlery and crockery to help people eat and drink more independently. Staff were not effectively deployed at mealtimes and people did not consistently provide the support people needed.
We found that checks (audits) on the quality and safety of the service were not carried out robustly. There were shortfalls in the way the service was led and the provider was not meeting some of the regulations.
There were breaches of the regulations relating to, staffing; safe care and treatment; meeting nutritional needs and good governance.
You can see what action we told the provider to take at the back of the full version of the report.
Although we saw that staff were mindful of infection control risks, there were some aspects of infection control and prevention that needed to be improved at the service, particularly when staff were supporting people with meals. There was some equipment at the home that was used by anyone. The service did not have a robust system in place to ensure these items were properly and consistently cleaned. In between our visits the registered manager had replaced waste bins with a more suitable design to help reduce the risks of contamination.
We have made a recommendation about the management of infection control and prevention.
The provider told us that they intend to upgrade and refurbish The Laurels. However, from the information they provided the improvements were not due to start until early 2019. The home was formerly a large house and therefore not fully adapted as a care home. The provider had plans in place to develop and upgrade the home.
The provider’s recruitment process helped to make sure that only suitable staff were employed at the home. There were some gaps in the record keeping but the registered manager addressed these matters straight away.
People were mostly supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service mostly support this practice. Where people’s level of capacity had changed, the provider took their previous wishes and choices into account. The service also liaised with the community mental health team. However, where people needed to have their medicines hidden in food (covert administration) the service had not acted appropriately. Most of the staff at the home had not received training with regards to the Mental Capacity Act 2005. There were other aspects of staff training that needed to be addressed by the provider.
We observed that staff treated people with respect and kindness. People told us that they were happy with the staff and that they were treated well. Care records were not always up to date and the service did not always fully support the independence of people living with dementia or sensory loss.
We have made a recommendation about involving people in decisions about their care and support.
We did not receive any complaints or concerns during our visits to the home. The provider had a complaints process in place and people were able to raise matters through this process or directly with the registered manager. The service held residents and relatives’ meetings which also provided a platform for people to have their say.
Social and leisure activities at the home were limited. People told us that there were not many things to do. Sometimes external entertainers visited the home and some people occasionally went out. Activities were provided on a ‘ad-hoc’ basis with no real thought about people’s interests or individual needs.
We have made a recommendation about supporting people with their leisure and social interests.
The people we spoke with during our inspection visits thought that the registered manager was approachable and supportive. People were confident that the registered manager would listen to what they had to say.
The provider has developed and interim action plan and has arranged for one of their quality managers to visit the service and review the auditing processes.