Laurel Bank Care Home

Laurel Bank is a purpose-built residential home situated in the Wilsden area of Bradford. The home provides accommodation and personal care for up to 63 people, including people living with dementia. Accommodation is provided over three floors. The Elizabeth Wing specialises in supporting people who are living with dementia. On the first day of the inspection there were 45 people living at the home. On the second day of the inspection there were 43 people living at the home.

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

Audits and quality monitoring were in place to monitor the quality of the service. Recent checks had highlighted some gaps in documentation. The management team had developed a comprehensive action plan to address the shortfalls. There had recently been a change of manager who was applying to register with CQC. They were passionate about making continued improvements to the service.

People’s care needs were assessed, and they received good quality person centred care from staff who understood their needs well. The service was caring and safe. People were relaxed and comfortable and they were treated in a warm and respectful manner. Some people’s care records required updating. There was a clear action plan in place to correct this.

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. Improvements were needed to fully evidence compliance with the Mental Capacity Act (MCA). We have made a recommendation about updating documentation to reflect people's involvement.

The building was designed to meet people’s needs. It was spacious, well maintained and homely. There was a choice of communal and activity areas and a safe outdoor space. The home was well organised and there was a large team of ancillary staff to support the care team. The atmosphere was relaxed and inclusive throughout. One health care professional described Laurel Bank as being “Welcoming and friendly and there is happy feel to the home.”

Staff had the skills and experience to support people appropriately They were knowledgeable about people and the topics we asked them about. They received a wide range of training and supervision. This was reviewed regularly to ensure staff had the knowledge and skills to meet people’s needs.

Medication was managed safely. The service was responsive to people’s health and social care needs. There were close links with health and social care professionals and other agencies to ensure people’s needs were met and changes responded to promptly. A diverse range of meaningful activities were available to support people’s social needs.

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

Rating at last inspection

The last rating for this service was requires improvement (published 27 December 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Laurel Bank 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 care home can accommodate up to 63 older people including people living with dementia in one purpose-built building. Accommodation is provided over three floors. At the time of inspection there were 45 people living at the home.

At the last inspection April 2018, the home was rated as requires improvement. Prior to this inspection in October 2017 the service was rated as inadequate. Following this inspection, the service is still rated requires improvement due to concerns around medication, staffing levels and lack of robust quality audits.

There was a registered manager in post. 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.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. However, there had been some recent issues in relation to staffing levels.

Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were not all up to date. This meant care plans did not always detail what care and support people wanted and needed.

Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s healthcare needs were being met and medicines were being stored and managed safely. However, there were concerns around the storage of topical medicines.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was very good. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they took action to make improvements.

We found the provider’s quality monitoring systems were not always working as well as they should be. Some of the concerns we found at our inspection should have been identified through a robust system of checks.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Laurel Bank Care 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.

Our last inspection took place on 10 and 11 July 2017 and at that time we found the service was not meeting five of the regulations we looked at. These related to safe care and treatment, person centred care, meeting nutrition and hydration needs, staffing and good governance. The service was rated ‘Inadequate’ and was placed in special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. This inspection was therefore carried out to see if any improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’

During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures. However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care and treatment. This is reflected in the overall rating for the service which is now ‘Requires Improvement.'

There was a registered manager in post. 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.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse.

The care plans in place provided staff with information about people’s needs and preferences contained individual risk assessments which identified specific risks to people’s health and general well-being, such as falls, mobility, nutrition and skin integrity. However, some care records we looked at required updating.

There were enough staff on duty to meet people’s needs and staff had undertaken training relevant to their roles. Staff told us there were now clear lines of communication and accountability within the home and they were kept informed of any changes in policies and procedures or anything that might affect people’s care and treatment.

Improvements had been made to the way people’s dietary needs were catered for and people’s mealtimes experience. People told us they generally enjoyed the food and we saw a wide range of food and drinks were available and people’s weight was monitored to ensure they had sufficient to eat and drink.

Private accommodation and communal areas of the home were well maintained and provided people with a pleasant, comfortable and safe environment.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA). This helped to make sure people’s rights were protected.

We saw the complaints policy had been made available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. Systems were in place to ensure people received their medicines safely and as prescribed.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required. However, it was too early for the provider to be able to demonstrate that the new processes were fully embedded and that these improvements could be sustained over time.

Our inspection of Laurel Bank Care Home took place on 10 July 2017. The inspection was unannounced.

Laurel Bank offers care and support to people with a variety of care needs and has a residential unit and a dedicated unit for people living with dementia, called the Elizabeth Unit. The accommodation is set over three floor, with a lift and outside space. The Elizabeth Unit is based on the third floor of the service. On the day of our inspection there were 62 people living at the service.

A registered manager was in post. 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.

Assessments to mitigate risks to people were in place. However, these were not always up to date or reflective of people's current needs.

Safeguarding processes were in place and staff understood how to keep people safe.

Although the service had a dependency tool in place to determine safe staff numbers, people, relatives, staff and health care professionals told us they had concerns about staffing levels. Call bells were not always answered in a timely manner. Staff appeared rushed and many interactions between staff and people were task orientated.

Safe recruitment procedures were generally in place to ensure staff were suitable to work with vulnerable people. Some staff training needed to be updated and we saw evidence of poor moving and handling practice.

We saw and people told us staff were caring but did not have time to talk or spend meaningful time with them. Regular staff knew people's care and support needs well, although staff who had been put on shift from another service did not. Some staff did not knock before entering people's bedrooms although most staff showed they respected people's privacy and dignity.

Medicines were not always managed safely. Although people generally received their medicines as prescribed we observed staff had not always ensured people had taken their prescribed medicines or taken appropriate actions when discarded medicines were discovered.

The service was mostly working within the legal principles of the Mental Capacity Act. More robust documentation needed to be in place regarding best interest decisions, consent and conditions relating to Deprivation of Liberty Safeguards (DoLS). However, a recent quality assurance audit had made recommendations for all covert medicines were reviewed to ensure appropriate paperwork was in place.

Some people's care plans contained detailed and person centred information. However, other people's care records and assessments did not reflect people's up to date care and support needs.

People had a sufficient choice and a variety of food. Arrangements were in place to meet people’s specific individual needs. Where required, referrals were made to the GP, community matron or dietician and measures put in place including monitoring food intake and prescribing nutritious supplements. However, some people's nutritional care plans and screening tools required updating to reflect current needs and better evidence of food and fluid intake was required.

People had access to health care professionals.

A wide range of activities were on offer according to people's choice although these were mainly based around the residential unit.

Complaints were documented with actions and analysis. However, some people and relatives told us they were concerned how their concerns would be treated if issues were raised.

A range of quality assurance processes were in place. However, these needed to be more robust to identify issues found at inspection.

Feedback was mixed about staff morale and the approachability of the management team.

Regular staff and residents meetings were held, which were used to help make improvements to the service.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we asked the provider to take at the back of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

Is the service safe?

We looked at the arrangements for handling medicines. We checked the records and a sample of medicines for people who lived in Laurel Bank. We spoke with the manager and senior staff. Overall we found some improvements were required to help make sure medicines are handled safely.

The people we spoke with told us they felt safe in the home and staff look after them. People have to be let in by staff to access the building so checks can be made. The service had a policy that all staff are to have a Disclosure and Barring Service (DBS) check prior to starting work. Staff told us they were familiar with the safeguarding procedure and would report if they saw anything.

Is the service caring?

People told us they were supported by kind and patient staff. Staff told us they offer encouragement for people to remain as independent as possible. We looked through peoples plans of care and saw their preferences, interests and aspirations had been taken into account and people received their support in line with their care plan. People using the service had completed an annual service survey. Where shortfalls or concerns were raised, these were addressed.

Is the service responsive?

People knew how to make a complaint if they needed too and felt it would be actioned. We looked at complaints received and found action had been taken and feedback given to the complainant. We looked at audits conducted by the service and found areas where there were shortfalls had been addressed. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service effective?

We found people's health and care needs were assessed with them and people had been involved in writing their plans of care. People told us they have their needs met and if they want anything they can ask for it. We spoke with staff who told us residents have their needs met. We observed people ask for support and staff assisted straight away when requested.

Is the service well-led?

We saw the service worked well with other agencies and professionals to ensure people received their care in a joined up way. One professional visiting the service told us communication was good and directions left for staff were followed. The service had a quality assurance system in place and concerns on audits were addressed promptly. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

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

On this inspection while we saw the systems in place for recording and administering medication had been improved and the service was now meeting people's nutritional needs. However, we found the records and reports completed by staff did not always provide accurate and up to date information and did not reflect the care and support people received.

The manager confirmed the service had applied to the Care Quality Commission (CQC) for a change in registration and no longer provided nursing care or employed qualified nurses. Details of the type of service and the regulated activities the service is registered to provide seen on page 2 of this report will be amended on completion of the change of registration.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. People who were able to tell us of their experience of living at Laurel Bank told us they were happy living at the home.

We talked to eight people who used the service and six relatives. Seven people who used the service said staff were approachable and did treat them with respect and one person commented that the staff 'did not have time'. Three people explained they could make choices about their day to day lives such as what time they wanted to get up or go to bed or if they wanted to take part in the activities in the home. Seven people told us they were satisfied with the care and treatment they had received.

Although most people told us they were satisfied with the care they were getting in the home, we found there were minor issues which could impact on people. Some had been identified by the management team in the home and they had already planned to respond.