We inspected The Laurels on the 25 and 26 November 2015.
The Laurels provides accommodation and nursing care for up to 52 older people, who require personal support and for those that have nursing needs, including poor mobility, strokes, Parkinson’s disease, diabetes, and people who were receiving end of life care. The maximum people to be accommodated was 48 as some rooms were doubles and would be used for couples or for those who want to share. There were 44 people living in the home during our inspection.
The original building has recently been added to with a purpose built extension to provide a safe comfortable environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over two floors with communal areas on each floor.
The Laurels Nursing Home is owned by The Laurels Nursing Home (Hastings) Ltd and the organisation has one other care home in the South East.
We last inspected the home in September 2013 and no concerns were identified.
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 and associated Regulations about how the service is run.
People commented they felt safe living at the Laurels Nursing Home. One person told us, “I feel safe and I’m happy here.” Another person said, “I came here as I wasn’t safe at home, I’m safe here.” However the management of medicines was unsafe and placed people at risk. Some people’s essential prescribed medicines were out of stock for up to seven days with no action plan put in place to protect their health.
Whilst care plans and risk assessments for people were in place, not all were reflective of peoples’ current needs and therefore not up to date. However when we spoke with the staff, they knew people very well and were knowledgeable of changes to peoples’ needs.
People and staff felt staffing levels were sufficient to meet the needs of the people they supported. One person told us, “Always lots of staff around.” A staff member said, “We are really well staffed and this is a reason I stay here, I don’t feel pressured and I can do my job well.”
Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff.
There was a focus on providing care and support that focused on the need of the person whilst supporting their individuality and identity. The management team told us, “Our staffing levels and the loyalty of our staff means we can give people the time they need, by staff that know them well.” We were also told, “We try to ensure that our residents lead the life they want.”
Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. There was an open culture at the home and this was promoted by the management team who were visible and approachable.
People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.
People told us they were happy living at the Laurels Nursing Home. One person told us, “I’ve been here since last year, and I’m glad I came, I like the staff and I have made friends.” Staff spoke highly about the people they supported and spoke with pride and compassion when talking about people. People’s privacy and dignity was respected and staff recognised that dignity was individual and should be based on what each person wants.
The provider had processes to support staff to carry out their roles safely and effectively. Staff were encouraged to take further qualifications to develop their careers.
Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
Staff said the management was fair and approachable, care meetings (handovers) were held after each shift to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management team was very good; and were always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.
The provider had systems in place to review the support and care provided. Audits were undertaken regularly, including those for care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.