The Laurels Care Centre

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Governance systems and audits were not effective in identifying or addressing areas for improvement and there was a negative culture for learning from mistakes. The provider was receptive to our feedback and had started implementing improvements quickly. There were immediate changes made to the managerial structure, extra staff have been deployed, The provider has already submitted an action plan in response to the concerns found at this assessment and how they will embed improvements into practice.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was mixed feedback regarding the leadership in the home, some staff we spoke with were positive regarding the culture and the vision of the service, whilst others were less positive. One staff member said, “I enjoy working here, I’ve not been here as long as some, but the atmosphere is friendly, we have meetings, but supervisions seem to have dropped off, “ Another staff member said, “There have been changes, its busy with different types of residents -I don’t know what the future is for the home, but it seems we have more and more complex needs, and more who have dementia. We need training as it’s very different.” Another said, “I don’t think things are quite right at the moment, we don’t get feedback or supervisions, we raise concerns, but I don’t really feel listened to.” Staff spoke to us about the vision of the service. One staff member said, “We all want to have a brilliant home, but we have seemed to have lost our way. Some things have just stopped, like laying the tables for lunch and lots of people no longer come down to have lunch, residents don’t engage with each other because they have such different problems, it’s a very different place recently.” Another said, “I think we are changing in to more of a dementia home, but we need the training and maybe more lounges, because they are all so different. I have made suggestions about specific areas because we also have younger people without dementia, and they get disturbed at times.” Other staff were not able to discuss the vision and values of the service. Some staff said that the management team was not always visible or approachable, one staff member said, “I have raised things but I don’t think I was really listened to,” and, “Well, we have a good manager, but I don’t really get the opportunity for supervision and due to family commitments I don’t attend all staff meetings, I think we need to improve communication and have more opportunities to discuss things especially our job roles.”

The culture at the service was difficult to assess because of the mixed feedback. It was, however clear that there was a barrier between staff and the management team. This meant staff did not always work together as a team and care delivery had become more task orientated than person centred. The management team and staff understood and supported people’s cultural and spiritual needs. People were treated equally, and their individual needs considered when completing care plans in line with their preferences. The management team knew people well, but this was not always reflected or updated in peoples care documents. Some families and people told us that they weren’t aware of who the registered manager was. They attended meetings but the registered manager did not attend, which meant there was a barrier to an open and transparent culture enabling people and families to raise concerns before they became complaints. Families have contacted us to raise concerns as they had gone to the management team and not received answers and didn’t feel listened to. The complaint log evidenced just two complaints in 2024 that state had been responded to, but the log lacked actions for staff to take forward and to learn lessons from. The service aimed to give people consistently good quality care and staff told us they worked together to try and achieve this. However, poor communication between staff, people, families, and some health professionals has created barriers. Individual staff supervision was not consistently provided for all staff, this meant staff could not discuss their job roles, learn what they needed or required to meet their role specifications or discuss any difficulties they were experiencing. There was evidence of team meetings being held, but the list of attendees was not recorded and therefore the management team did not have an overview of which staff may need to be kept informed of outcomes of meetings.

The management team was committed to improvement and was open and transparent about the improvements made and those that were on going. We were told that the focus of the service was to ensure people were safe and supported in the right way, and that any learning was taken forward positively. Staff said, "We learn from mistakes, we had a lot of missed signatures on the MAR (medicine administration records), so we now are using the EMaR (electronic medicine administration record) "Our wound recording was reviewed as it was not being completed in full, we had extra training and its improved." "We don’t really get much direction about falls apart from use sensor mats and checking them all the time."

Organisational processes were in place to promote an inclusive environment and compassionate leadership, but these were not always being followed. There were systems and processes in place to support staff development and progression within their roles. Care staff talked of how they were supported to extend their role, to become team leaders. However, there was a lack of support and supervision to monitor this transition. Specific training for health conditions that were new to staff had not been sourced before the people arrived to live at the home. This meant that staff did not always have the necessary knowledge or skill base to provide consistent safe care, specifically in relation to dementia, and motor neurone disease. Other training and competencies of staff for supporting and monitoring peoples’ conditions, were not completed by all staff. For example, catheterisation, venepuncture, and syringe driver. We have been assured that training and competencies were being organised. A new clinical lead had commenced work following our assessment and would be taking training forward. The provider told us they supported staff to attend external training, online training and meet with other staff within the organisation to share learning and reflect on practices.

Two staff told us that felt able to raise concerns One staff said, “I would bring my concerns to X and X (the area manager and deputy manager).” Another said, “I would go to the office, and speak to one of the managers.” However, there were also staff, who didn’t know how to raise a concern if not able to speak with management, or if it concerned management. This was discussed with the management team during the assessment process and further training was to be provided along with the management team understood their responsibilities under the duty of candour. The Duty of Candour is to be open and honest when untoward events occur.

The management team were open and transparent during the assessment process. They acknowledged when things had gone wrong and demonstrated how they were going to take things forward with immediate effect. There was however no evidence that the duty of candour had been applied regarding peoples’ multiple falls. The provider had up-to-date whistleblowing policies and procedures which were in line with current guidance. Some staff told us were supported and enabled to voice their views and concerns, but were not sure they were listened to, as no actions had been shared. They were aware of the whistle blowing policy and would not hesitate to use this system if they felt people were at risk. People and families, we spoke with confirmed they knew how to complain, and a copy of the complaints policy was available in the home and on the service website. A record of complaints was held in the service. These included the information on the complaint and how this was responded to. We saw complaints had been responded to, but as previously reported, actions and lessons learnt, were not reflected within the complaint log.

Staff told us, “We get training in equality and diversity, its pretty good here, the support from seniors is very good.” Other staff said, “When we do our induction, we get all the policies to read and sign off on.” Staff said they felt they were respected as individuals and that they could approach management for support, if their home circumstances changed, and they need to look at their shift times being arranged to fit in with family commitments.

The provider had policies and procedures in place to ensure workforce equality, diversity and inclusion was promoted. For example, there was an Equality, Diversity and Inclusion Policy and an Equal Opportunities policy. Staff undertook training in equality and diversity. The registered manager told us staff were treated fairly. They tried to support staff by being flexible with work patterns, ensuring they followed all employment laws and being supportive of staff. Staff felt that they were supported in all employment practices. However, not all staff received regular 1-1 supervisions, some staff had not attended staff meetings and staff told us that there were no de-brief following incidents, accidents, or events. Staff told us, “I feel group supervisions would be helpful so we can support each other and learn from experiences.”

The management team demonstrated a good understanding of the regulatory requirements. They told us they analysed and reviewed audits each month and action were taken to address shortfalls. The registered manager said, “We have a range of audits that are completed online and analysed.” However, these were not completed in full the area manager confirmed that through organisational audits they had identified some of the issues we found and had been about to address them with the registered manager as we began our assessment.

The management team were open in acknowledging improvements were needed in their governance processes. Leadership changes occurred during the assessment process and the area manager had immediately taken action to address the shortfalls we found, and this included root cause analysis regarding falls, pressure damage and investigation into poor call bell responses. He also told us of implementing a service development plan to address shortfalls. However, it is acknowledged that this will take time to embed into everyday practice. The provider's governance processes were not effective, and they did not effectively monitor the safety and quality of the service or promote good outcomes for people using the service. We identified concerns with the provider's oversight of risks to people’s health and safety. There was a lack of oversight of care planning and risk assessment documentation, and we identified a number of concerns with the management of safeguarding, accidents, and incidents. The provider did not have effective oversight of staff knowledge and competence and a lack of robust processes were in place to determine what staffing levels were required to meet people's individual needs and preferences. During the inspection process, staffing levels were increased to address the call bell response and monitoring of people.

People told us that appropriate health and social care professionals were contacted appropriately when required. They told us that they could see a GP, but sometimes not as quick as they wanted to. One person said, “I do see a GP, I have also seen a nurse regarding my bloods.” And another told us, “I see a lady who does my feet, and I have seen an optician.” Another person said, “I don’t leave the home anymore; we don’t really get the opportunity which I miss. I would like to go out to the bank but at present it’s not possible, so my family do it. I think it’s difficult for someone to come with me,”

Staff told us how they would contact relevant external professionals to meet people’s needs. The staff team told of how they made referrals and the input in to care plans to reflect this. However when we discussed certain referrals such as to the frailty team and joint rehabilitation community team for people whose mobility is decreasing they said, “Well they are in bed most of the time”, but there were no reasons documented for this in people’s care plans or risk assessments.

We received feedback from five health professionals. Some told us that the staff appeared to be knowledgeable about people’s needs. Some said that the communication from the service was poor and referrals were not always made as promised for specialist support or input. One health professional shared concerns about people being cared for in bed without a clear rationale for doing so.

The staff team told us they were proactive in building relationships with other organisations and into the local community to improve outcomes for people. However, there was work to be done to ensure younger people were enabled to access services and clubs that would give them the opportunity to mix and make friends of their own age. One person was expecting to move in to supported living but there was no preparation yet or support sought from outside health professionals to help them on this journey. Staff and leaders told us they worked in partnership with key organisations to support care provision, service development and joined-up care. We approached these partners whose feedback was mixed. We have shared the feedback with the provider so they can approach these agencies to build a more positive relationship and use learning to promote good outcomes for people. The medicine provider gave positive feedback regarding the staff and the service, and this has also been shared with the provider to share with the staff. The provider has sent out surveys to health partners and was currently analysing the information and has already had staff meetings and arranged a family and resident meeting that will address some outstanding concerns and provide action plans. Staff worked with various external agencies including, GPs, community nursing teams, Tissue viability nurses, social workers, and Local Authorities.

Discussions with the management team and staff demonstrated they recognised the importance of learning lessons and continuous improvement to ensure they people received care and support that was safe and effective. One staff member told us, “We are continuously learning; we welcome feedback because we learn from it.”

Safeguarding concerns, complaints, accidents, incidents and near misses were recorded but there was minimal evidence of review, root cause analysis and analysis. Therefore, emerging themes were not always being identified and preventative action not taken to reduce the risk of reoccurrence. People, families, staff, visiting health professionals were given opportunities to feedback their views about the service and quality of the care they received. These are currently being analysed by the area manager and will be shared with all parties. The management team at this time were not able to demonstrate how people, relatives and staff were involved in making decisions about improvements needed in the service. Actions from meetings held were not recorded or actioned. We received mixed feedback from staff about how well they were supported to learn and develop. The management team were not able to evidence a clear strategy for addressing shortfalls and driving improvement. During the assessment, the area manager confirmed they were reviewing their service development plan to ensure it included all relevant areas and more clearly evidenced priorities for driving improvement. The provider's processes had not been fully effective in driving continuous improvements and learning. For example, where safeguarding and complaint investigations had identified concerns with poor personal care, record keeping and care plans which were not fully reflective of people’s needs, it was not clear there had been any follow up action taken to ensure improvements were made and sustained. During our assessment, we identified a number of concerns which had been raised previously, such as poor oral health, nail care, incorrect mattress settings and poor response to call bells. This demonstrated a poor culture of learning and improvement in the service.