Laurel Care Home

Laurel Care Home is a family run nursing home which is registered to provide accommodation and nursing or personal care for up to 60 older people. At the time of our inspection there were 56 people living at the home.

People’s experience of using this service:

Staff training is developed and delivered around individual needs and learning styles. The provider had a pro-active, detailed training process that fully supported staff and actively encouraged their future professional development.

Laurel Care Home staffed above the core numbers of trained staff required. This ensured people received individual, person centred care and support at all times. Staff were themselves supported with a system of detailed, regular supervision and annual appraisals. Staff felt very well supported and commented positively on the range and quality of the training they received. Staff told us the training was “Excellent”.

The service used innovative designs to adapt and improve the premises to enrich and benefit the lives of people living at Laurel Care Home. People were engaged and involved in design changes and their views were listened to and respected.

The service worked collaboratively with healthcare professionals and provided good end of life care. People experienced a comfortable, dignified and pain free death. There were members of staff with the specific skills to understand and meet the needs of people and their families in relation to emotional support and the practical assistance they needed at the end of the person’s life. Staff were also supported by the service with empathy and understanding.

People and relatives consistently told us how they were treated with exceptional warmth, compassion and kindness. All staff told us they felt extremely well supported, valued and felt proud to work for Laurel Care Home. Many staff told us Laurel Care Home was the best home they had ever worked in. People and relatives gave high praise for all aspects of the service and the care and support that they received. One relative told us, "They care for everyone as if they are family. I can't fault them at all, they are simply amazing."

The service was very well-led. The registered manager demonstrated how their open and supportive management style and use of innovative schemes and ideas had sustained continual development and improvement throughout the service. They demonstrated ways of working that improved the outcomes for the people they supported. They were clear about their expectations relating to how the service should be provided and led by example. Staff felt extremely well supported and spoke highly of the registered manager and management team. Staff were passionate, committed and motivated to delivering quality person-centred care to people. Staff were proud of the service and morale was high within Laurel Care Home.

Staff demonstrated a good understanding around the provider’s safeguarding procedures and understood how to recognise potential signs of abuse. People and their relatives told us they felt very safe at Laurel Care Home.

People had detailed assessments completed for them which gave staff clear guidance to ensure people were cared and supported in ways they preferred.

People received personalised care and support in an individualised way, which was planned and delivered to meet their needs. Each person was respected as an individual, with their own social and cultural diversity, values and beliefs.

People’s medicines were being managed safely, stored securely and administered by trained staff.

People were treated with respect, kindness and dignity by a staff team who showed genuine, warmth, compassion and commitment to provide people with the best levels of person centred care.

People and their relatives were fully involved in assessing and planning the care and support they received. People’s ongoing health care needs were continually assessed and people were referred to health professionals when required.

The registered manager and staff team had built effective relationships with external health and social care organisations. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible.

People and relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns. People and relatives were encouraged to share their views about the service which were welcomed and acted upon.

There were a range of audits, policies and procedures in place to monitor the quality and safety of the service and ensure a culture of continuous improvement and learning took place.

More information in Detailed Findings below.

Rating at last inspection: Good (The date the last report was published was 30 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service has remained rated as Good overall.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good.

The service had a registered manager. 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.

Laurel Care Home provides accommodation for persons who require nursing or personal care for up to 60 people. At the time of our inspection 56 people were living at the home.

Accommodation at the home is provided over two floors, which can be accessed using stairs or passenger lifts. There are large garden and patio area’s which provide a safe and secure private leisure area for people living at the home.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People who were able to talk with us said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly.

The provider operated safe and effective recruitment procedures.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained.

Training records showed that staff had completed training in a range of areas that reflected their job role.

Staff supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people's rights were protected.

People were involved in their care planning. Care plans were amended to show any changes and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

This is a summary of what we found '

Is the service safe?

The provider had taken action to help ensure that people who use the service were safe. Staffing levels had improved and were more consistently in line with the levels determined by the service as being required to meet people's needs. We found that a dependency assessment tool was now being used to inform staffing levels. The registered manager monitored the dependency assessment records to ensure that staffing levels continued to reflect the needs of people using the service.

We spoke with seven people who used the service. They told us they were able to summon staff if they needed help. One person said, 'They come within a few minutes'. Another person said, 'They come reasonably quickly when I press my buzzer'. This person told us how pleased they were with the care they received. They explained, 'The carers are so brilliant, they are all so cheerful and helpful, I have a laugh with them, they have time to sit down and have a chat with me, they indulge you in every way'. We saw that people received sensitive and unhurried support when they were unable to feed themselves.

Staff told us that there were sufficient staff to meet people's needs. All of the staff told us that team work was good and that staff really supported one another. When agency workers were required, the same workers were used, where possible, and this helped to ensure better consistency of care.

Arrangements were in place to monitor how quickly staff were able to respond to people's needs. These arrangements needed further development to ensure that they were an effective tool for monitoring the timeliness of care people receive. However, our observations on the day of the inspection indicated that people were having their needs met in a responsive manner by staff who were familiar with their needs.

Staff were suitably qualified, skilled and experienced to undertake their duties. We found that both nursing staff and care staff updated their essential training, for example moving and handling and fire safety. All of the staff we spoke with confirmed that they received regular supervision which helped to ensure that people were cared for by staff who understood their role and responsibilities.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

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

Is the service safe?

People's care records contained assessments which covered the risks associated with staff providing the care and support they needed. This helped to ensure that people who used the service were safe because staff had taken action to identify and assess the risks to their health and wellbeing.

People told us that they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported.

There were systems in place to help ensure that suitable and competent staff were recruited to care for people who used the service.

The deputy manager was aware of the processes to follow to ensure that staff who were no longer fit to work in health and social care were referred to the appropriate bodies.

Systems were in place to ensure that the service learnt from incidents and accidents, comments and complaints.

We found that the service was not always able to respond to people's needs in a timely manner as it was not consistently operating at the staffing levels determined by the provider.

Is the service effective

People's needs had been assessed and care and support was planned and delivered in line with their individual care plans. Care plans were detailed and regularly reviewed to ensure they remained up to date.

There were effective systems in place to reduce the risk, and spread, of infection. The provider had an infection control policy which had due regard to the Departments of Health's Hygiene Code of Practice. We observed that the home was clean and hygienic. One relative told us, 'The cleaning staff are very good'they don't just clean, they move things around to make sure it is really clean'.

Staff we spoke with were informed about people's needs and were able to tell us about the care they provided. This information was consistent with what was recorded in people's records.

The service worked effectively with other providers to ensure that people received co-ordinated care, treatment and support.

Is the service caring?

People were supported by kind and attentive staff. Staff treated people with dignity and respect and we saw that care was delivered in an unhurried and sensitive manner. One person told us that the staff were, 'Very kind, they could not treat me any better'. A relative told us, 'The staff are top notch, they are second to none'.

People's preferences, likes and dislikes had been recorded and care and support was provided in accordance with peoples wishes.

Staff were able to tell us how they anticipated people's needs, for example, by making sure that their pain was managed, or that a person who was photosensitive to light did not have their room too bright.

Is the service responsive?

The service had measures in place to review people's needs on a regular basis to ensure that their care plans remained up to date and reflected their current needs.

People knew how to complain and told us that they were confident that action would be taken where necessary.

Is the service well led?

The service had a consistent management structure that maintained oversight of the home and provided leadership to the staff team. The management team were supported by a provider who visited the service regularly. One relative told us, 'The owners are very good, they muck in and you see them around the place'.

The deputy manager was able to demonstrate a good knowledge of the needs of people who used the service and their care and support needs.

People knew how to complain and told us that they were confident that action would be taken where necessary.

Staff told us that they felt part of a team and that the manager was approachable. One staff member told us, 'Coming to work here was like a breath of fresh air'.if you need training, you just need to speak with the manager and they have it covered'. Another told us that there was 'Good teamwork, the manager is approachable'its not like coming to work'I feel part of a family'.

The service had a robust quality assurance system in place to monitor the quality of the service and identify where improvements could be made.

During the inspection we observed people participating in activities with staff including sketching classes, music sessions and playing board games. People using the service decided how they occupied their time and were provided with a variety of activities to choose from.

A family member told us "the staff are very approachable and friendly. They could be quicker when answering the buzzers as it quite often takes them a very long time. Everyone seems generally well looked after".

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis. One person spoke about staff saying "the staff are lovely. They know what I like and what I don't like and they listen to me. They would never make me do anything I didn't want to do".

Staff we spoke to lacked knowledge and understanding about the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff safeguarding training was out of date and had not been completed since September 2010.

We looked at medication records for three people and found that medication was disposed of appropriately. We saw that audit systems were in place which ensured that tablets and other forms of medication were accounted for and stored in controlled drugs cabinets prior to disposal. Records we looked at were accurate and medication was stored and disposed of appropriately.

Staff received appropriate professional development. We saw training records that showed us that staff had undertaken an appropriate range of training. We spoke with staff members who told us that they found the training useful as it helped them in providing care to people with different support needs.