The Laurels Care Centre

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

Incidents and accidents were recorded, however we were not fully assured that lessons had been learnt from these and appropriate actions taken to prevent a re-occurrence. Concerns of a safeguarding nature had been raised, but there was no supporting evidence that safeguarding referrals had been made regarding the high amount of falls and pressure damage. Staffing levels had not always been sufficient to keep people safe and to monitor their health and well-being, which had contributed to poor call bell response time. Staff were caring and kind but had lacked the supervision/support and training to provide safe consistent care. Staff had undertaken equality and diversity training and told us diversity was valued at the service. Medicines were administered as prescribed and managed safely, however we identified some areas of practice that needed improvement in relation to PRN (as required) medicines and the management of eye drops and topical creams. The premises were clean and well maintained and accessible to all the people who lived there. There were well maintained garden areas that people had access to and were seen to enjoy.

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.

The registered manager told us that lessons were learned from accidents and incidents, and shared with staff immediately to prevent a re-occurrence. One person told us, “I have had a fall, they have asked me to ring if I want to go anywhere, but I don’t always remember to.” Another person said, “I think they notice things, they do make sure I’m safe.” and “I sometimes feel unsafe, but that’s me, not the staff, because I have to rely on them to do everything nowadays.”

Staff told us, “At meetings we get told of issues and then we discuss them, but I'm not sure we look at lessons learnt or how." At handover, we get told of recent falls and what we need to do, but if we are off we don’t get the information unless we have time to read people’s care plans, which we don’t always do.“ Another staff member said, “We get told when an accident happens and we get told to do more checks, we record our checks and respond to alarms, but we don't get updates as to cause or what to look for, or what may be the problem” The registered manager said, “We record all accidents and incidents and complete the spreadsheet with lessons learnt.”

The registered manager told us that lessons were learnt from accidents, and that incidents and accidents shared with staff immediately to prevent a re-occurrence. However, records of incidents and accidents shown to us in a tracking document, provided minimal reflection of possible cause and lessons learned. Analysis was not always effective and did not reflect lessons learnt. Whilst the registered manager understood their duty of candour for falls, we were not assured that families were informed of all falls as this was not recorded or reflected within documentation. The overview and log for accidents and incidents told us that there were some people who had had a high number of falls over three months. For example, one person had had 30 falls over two months, another person 15 and another 10. We reviewed their individual care plans and risk assessments and found there had been minimal actions recorded to assure us of their continued safety, or that staff had looked at ways to manage their falls apart from sensor mats and 15-minute checks. They had not thought of why the person may be wanting to leave their bed or their room, or tried alternative location such as lounge areas. There was a lack of cross referencing between accidents and care plans/risk assessments which had not protected them from harm. Staff and leaders were aware of the high number of falls which had previously occurred at the home, though some staff were not aware of the extent of recurrent falls. When talking with staff they told us after an unwitnessed fall, they assisted people back to their room/bed after checking them for injuries and implemented 15-minute checks, however this had impacted on people’s ability to move freely within the home and their choices.

We received mixed feedback from people and families. One relative said, “Admission was hurried by the service – all agreed within 24 hours and moved in. No assessment was done face to face prior to him moving in as far as I know.” Another told us, “They are making referrals to the dietician and SaLT (speech and language teams) as well as respiratory team.” We were also told by some people and family members, there had been no choice of room given, it was just allocated to them.

The management team told us how they met and assessed people’s needs, before they moved into the service, to ensure their needs could be met safely. However, they did also confirm that sometimes the admission process was pushed forward by other health professionals and they received a telephone handover and then completed the pre assessment form without a pre meet with the person or family. One senior staff member said, "Sometimes the handovers were not as thorough as they should be." And "We are admitting people, but they are becoming more complex, and we need training."

Views that we gathered from health professionals were mixed. Some told us that the staff knew people and their care needs well, and that they receive a good response when asking for information from the management team. Other health professionals said they had experienced poor communication, late referrals and in some cases they said they had been told referrals had been made, however the referred to services, had no knowledge of these.

We received varied responses from people and family members about the initial transition for their loved ones into the service. Some felt that information had been missed in the assessment of the person’s needs, such as the fact that one person slept in their specialist chair for comfort and had to ask that the bed was removed when they moved in. The management team acknowledged that at times admissions were rushed and felt that this was an area they could improve to ensure smooth transitions into the home. Staff worked alongside other ASC and health organisations to ensure people received appropriate care. There was regular contact with local authority, social worker, community nurses, hospice at home team and doctors. Staff told us they knew the health professionals well and told us of collaborated teamwork. "I think we work well together.” However, a health professional felt that “Better communication and further specialised training would assist in planning treatment.” Another health professional said, "They know their residents well.” People were supported to maintain their health, attend appointments both inside and outside of the service. However, people's care records showed referrals were not always made to healthcare professionals in a timely way. One person’s weight had decreased by 10 kgs from June 2024 to August 2024, this was not progressed until late August 2024. The management team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, they had an information sheet with vital information that included how to communicate with as well as their physical health complications. These ensure that hospital staff have vital information about them and their health. However not all of them were completed in full and the registered manager informed us that this was a work in progress.

People told us that they felt safe, and staff were kind and helpful.” One person said, "I do feel safe, they are good staff, and my room is lovely,” and another said, “I feel safe most of the time, I get a little anxious if I don’t recognise the staff, but they do their job.”

Staff told us they received safeguarding training, and they knew what actions to take if they were concerned someone was at risk of harm through abuse or discrimination. However, some staff said they were not sure who to raise concerns to, if they felt unable to tell their managers.

We saw empathetic interactions between staff and people. Staff were calm, which supported people to remain calm. We saw staff and people interacting in a positive way. However, there were a large amount of people in their rooms on bed rest that received minimal staff interaction

We were not fully assured that all notifications of possible harm were referred to the local authority in respect of high number of re-current falls. However, we have been given assurances that safeguards will be put in place going forward. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. The documentation supported that each DoLS application was decision specific for that person. For example, regarding restrictive practices such as locked doors, sensor mats and bed rails. We saw that the conditions of the DoLS had been met. However it was identified there was no evidence of best interest discussions or meetings for those people that were on 15 minute observations to prevent them getting out of bed and leaving their room and this had not been reflected within their risk assessments or care plans or thought of as potential restrictive practice. There was a high number of people on continuous bedrest, without a clear rationale recorded or a best interest meeting held with family and health professionals. During the assessment process, it was acknowledged that this had been noted by the area manager and practices reviewed.

Some people told us staff supported them to manage risks and stay safe. Comments included, “I do need help to walk, and staff help me, I also need help to wash and dress now as I'm not that safe anymore.” Another person said, “I was at home but had falls, so I came here to be safe, it’s not what I really wanted but it’s what I needed.” However some relatives told us that frequent checks to keep people safe did not always happen.

Staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included management of behaviours, mobility and when people may become distressed. Staff we spoke with knew the people they supported well but did not understand the day-to-day risks well, such as not eating and drinking, concentrated urine, lowered blood pressure -there was a lack of professional curiosity shown by nurses.

Communal areas and bedrooms were safe for people and had been risk assessed for the people who live there. Staff were seen to move people safely with equipment and when assisting them to walk safely and independently. Moving and handling equipment had been well maintained and regularly serviced. Fire doors were clear from obstruction -all fire extinguishers were in date and appropriately attached to the wall for safety. Air pressure mattresses were checked during our site visit and were found to be at incorrect settings, and records did not guide staff on the correct settings to use. The deputy manager checked all mattresses during the site visit and reset them against peoples weights. A new check list with guidance for staff to follow has been introduced. Some people had specialised wheelchairs which were not being used and when we asked staff about this, they said people stay in bed. We saw that many people who remained on bedrest were socially isolated and there was no rationale for them to remain on bed rest.

The provider used computerised care plans and risk assessment to plan care and monitor risk. Most contained the individual risks to people and included clear guidance for staff on how to manage and minimise risks. However, we found areas of concern that identified people were at risk from unsafe care, such as health checks and records of weight loss were not always accurate and had not been acted upon to understand why, or to minimise the impact of this on their health. There were people who had been assessed as being at high risk of developing pressure damage and preventative measures such as pressure relieving mattresses were in use. However not all were set correctly for the individual person’s weight, which meant that the risk of pressure damage for people known to be at risk was not mitigated or managed. No tracking or analysis had been carried out to try to understand any patterns or themes in the high number of pressure sores recorded. During the site visits there were a high number of people who remained on continuous bedrest, without any rationale or best interest discussion documented. The impact of people being kept in bed was an increased risk of skin damage, incontinence, social isolation, and increased mobility problems. The nurse call response audit was requested and identified poor response to call bells. There was no action plan in place to address this. The area manager has responded immediately by increasing staffing and analysing the response times for possible themes and trends. We received immediate assurances and were given evidence that these areas of concern had been addressed to ensure people’s safety, however these need to be embedded into everyday practice.

People told us that the premises and their room was safe. “Very clean and tidy, sometimes the carpet needs hoovering, but I don’t complain!” Another person said, “My room is kept nice, best thing is, I don’t have to do it.” Relatives told us – “It’s well maintained, very comfortable,” and “” I have no complaints about the environment, quality furniture and well maintained.” One relative said, “Really good security, too good because sometimes in the evenings, I can’t find staff to let me out.” Another relative told us, “I think the home is welcoming and safe, the gardens are lovely and there are spaces for us to see our relative in private.”

The staff told us, “We check rooms and communal areas daily as we work, issues are dealt with immediately.” Another staff member said, “There are audits every department do, we check equipment before we use it, like slings, hoists and wheelchairs.” Another staff member said, “They do audits and I know all our equipment and fire precautions are checked - it’s a safe place to work.”

The environment was clean and well maintained, portable appliance tests (PAT) had been carried out to check equipment was in good working order. Fire equipment was in place and documentation showed regular tests had been conducted. An emergency “grab bag” was located in the reception area in a locked cupboard with fire folder containing individual’s personal evacuation plans. The garden areas were attractive and safe for people who lived with mobility issues. The front door and all doors were key coded and there was CCTV in corridors and communal areas.

The provider conducted comprehensive checks and audits that ensured the environment was safe. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property.

Mixed feedback from people and their families. Families told us that they felt more staff would be beneficial. One said, “Sometimes we don’t see any staff, it can be very busy,” and “Staff are lacking at weekends.” Another told us, “The staff team are good, I think they are short [of staff] sometimes, but they seem kind and respectful.” One person said, “Sometimes they are short staffed, like this week.”

Staff had differing views about staffing levels in the service. Some staff told us that there weren’t enough staff to give the care required to people., “We can’t give them the care they deserve, we try but I feel we could do better.” “We need more staff, our residents are more complex and take time - we get interrupted by bells,” and “We don’t get time to spend with residents.” An agency staff member told us, “As an agency nurse I seem to do just medicines and dressings full on, I don’t always get a break but I like coming here, I know the residents now.” Another staff member said, “We are okay staffing wise,”

From observation on the site visit, staff were not always available when needed, especially in communal areas. The activity staff supported people well, but staff lacked oversight of people’s needs.

Rota’s confirmed staffing levels were consistent, with the use of agency staff when required. During the site visits, staff shortages had been covered by agency staff. From our observations it was identified that there were a high number of people that remained in bed. It was not clear from records whether this was their choice or a care decision. Personal care was still being delivered at midday. Whilst this may be people’s preference it was not recorded in their care records, and they were unable to tell us. Families said, “I’m not sure why they are in bed, I presume it’s their frailty.” This had an impact on people’s care. Records told us that oral health had not been undertaken and people’s nails needed attention, records for showers were minimal and some people told us they weren’t offered the choice of a bath or shower. One person told us, “I generally have a strip wash, I don’t think I’ve been offered a shower.” Accident and incident records highlighted that there had been unwitnessed falls. Staff told us that they could not provide the monitoring needed to mitigate risk for these people. The call bell response audit from 25 August 2024 to the 27 August 2024 identified people were waiting up to 40 minutes at times for staff assistance. The area manager has taken immediate action by increasing staff numbers to include a ‘floater’ who will be deployed to monitor those at risk of falls and be first responder to call bells. This will be consistently monitored and therefore risk was being managed. Staff had not always received the appropriate training to meet the needs of people currently living in the home. For example, not all staff had received training in supporting people who lived with motor neurone disease, dementia, learning disability and diabetes. We were assured that this training had been progressed. The provider followed safe and effective recruitment practices. . Records showed staff belonged to the relevant professional body.

People and families told us that they were generally happy with the cleanliness of the home. One said, “It’s mostly good, some areas are sometimes a little grubby mainly at the weekends.” Another said, “It smells nice, no odours or anything, but carpets need cleaning.”

Staff were aware of their responsibilities in relation to infection prevention and control. Staff told us, “We all do infection control training and food safety training," and "We have to do training and we get updates on infection control measures and guidance."

We did see staff leaving rooms following personal care wearing gloves before disposing of them. Some bedside tables were sticky with residue and floors in need of cleaning in some bedrooms Communal bathrooms were clean and functional

 There were organisational infection control policies and procedures for staff to follow and the provider had cleaning schedules in place to guide staff on maintaining the cleanliness of the care home. The provider followed current best practice guidelines regarding the prevention and control of infection and all policies and procedures were up to date. There were systems in place that ensured the safe disposal of medical and domestic waste. Audits for infection control were completed but lacked detail of any actions taken and they did not reflect the feedback from families. The management team completed an infection analysis monthly, we looked at four months in 2024. It contained details of each infection sustained within each month, and how treated, whether it led to hospital admission and additional comments column for action taken. However, records showed one person who had four infections in a short space of time, but there had been no follow up to see if actions taken had lessened the frequency. This was also not reflected in that persons care plan or risk assessments.

People told us, “I always get my pills, sometimes a little late but no issues,” and “I am fine, no problems.” However, people also told us, “I’m not sure what I’m taking, I just accept them, I don’t get offered pain killers, I have to ask quite a few times before I get it.” Families told us, “I have not really been involved in medicine issues, I expect they would inform me of changes.”

The service has recently transferred over to an electronic medication record system. Staff who gave medicines told us they had received training on the new system and had been assessed as competent. One staff member said, “After 2 days I felt it was a better system and safer.” Another said, “Much better system, it alerts us or the pharmacist of any potential errors.”

The electronic medication system confirmed people received their medicines as required. The system alerts staff immediately if a medication is late or missed. We saw medicines were stored securely when being given out, medicine givers ensured the trolley was locked when left unattended. Medicines prescribed on an 'as and when required' basis (PRN) had protocols which informed staff of when the medicines were required, for example, pain relief. However, these were generic and did not always contain enough information to support staff in administering medicines consistently, as intended, this included End of life medication. Not everyone had a pain management care plan and there was inconsistent use of pain assessment charts.