The inspection took place on 9 July 2018 and was unannounced. The last inspection took place on 18 June 2015. This was a focused inspection to follow up on a breach of regulation identified in December 2015 following a comprehensive inspection. The breach was in respect of Regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014. At the focused inspection we found this breach was met and the service was rated as Good.The Laurels 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.
The Laurels Care Home is a care home close to Congleton town centre. Originally a private house it has been renovated and extended to provide care to older people. It is a two-storey building and people live on both floors. Access between floors is via two passenger lifts or the stairs.
At the time of the inspection 33 people were living at The Laurels Care Home.
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.
During this inspection we found the provider was in breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breach related to staffing. Our observations showed that at different times of the day there were not enough staff on duty to ensure people received the support they needed to ensure their safety and well-being. Considering our findings, we have also made a recommendation regarding more robust monitoring at management level of the staffing arrangements in the home to ensure consistent staffing numbers are maintained.
Our observations showed when staff were supporting people they were attentive and tried to make people as comfortable as they could. Their time was limited as the home was busy however when assisting people they took time to understand people’s different ways of communicating and to respond appropriately to their requests. Relatives were complementary regarding the attitude of staff who were described as caring and patient in their approach. People told us they liked the staff team and they were polite and respectful.
Staff had a good understanding of people's individual care needs and appropriate referrals to external healthcare professionals took place. Guidance and advice that was provided was being followed; this meant that people’s overall health and well-being was being safely and effectively supported. Feedback from health and social care professionals who had input into the service was positive.
Systems were in place and followed to recruit staff and check they were suitable to work with vulnerable people.
We found the environment to be clean and free from any odour. Staff had access to protective clothing such as, gloves and aprons to support the control of infection.
The premises and equipment were subject to safety checks to ensure they were safe and well maintained. The premises was kept in good decorative order and there were some adaptations to promote a dementia friendly environment. The registered manager was aware that further work was needed in this area to fully support people with dementia. For example, more signage throughout the home to aid people's orientation.
People’s medication was safely managed and they received it on time and as prescribed. Staff were trained and deemed competent to administer medicines.
Staff had a good understanding of people's individual care needs and appropriate referrals to external healthcare professionals took place. Guidance and advice that was provided was being followed; this meant that people’s overall health and well-being was being safely and effectively supported.
Assessments of people’s care needs had been carried out and people had a plan of care which provided in the main guidance for staff on how to meet their needs safely and effectively. We did however find that there were instances where staff had not inputted all the required information regarding people’s support. We appreciate this was work in progress and the registered manager provided us with assurances this would be actioned.
Relatives were involved in the planning of their care to support their family member and they were kept up to date with matters relating to their health and welfare.
Staff received training and support to help them support people in accordance with their individual need. Staff confirmed they received a good standard of training to support their learning and development.
Risks to people’s safety and wellbeing were recorded to enable staff to support people safely whilst promoting their independence. Accidents and incidents were recorded and an analysis undertaken to look for trends or patterns to minimise the risk of re-occurrence.
Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person's mental capacity was made to protect them. This included applying to the local authority for a Deprivation of Liberty Safeguard (DoLS) for people.
Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. Staff had received training and knew what action to take if they felt people were at risk of abuse.
A system was also in place for raising and addressing concerns or complaints and people living at the home and their relatives told us they would feel confident to raise a concern. Complaints received had been logged and investigated but outcomes were not recorded. We brought this to the registered manager’s attention to action.
People were supported to eat and drink enough to maintain a balanced diet and meet their dietary requirements. People were offered a good choice of meals and alternatives were offered if the menu choices were not to their liking.
The provision of social activities was somewhat limited as the activities organiser was assigned one and a half hours a day to organise and facilitate social events. People were encouraged to participate and appeared to enjoyed the activities arranged.
There were systems in place to consult with people who used the service, to assess and monitor the quality of their experiences. This included completion of feedback surveys and meetings.
Systems were in place for checking the quality of the service to maintain standards and drive forward improvements; this included audits at service and senior management level.
The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The ratings from the previous inspection were on display in accordance with requirements.
You can see what action we took at the back of this report.