Archived: Lauriston House

Updated 3 July 2019

The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: The inspection team consisted of two inspectors, two CQC medicines team inspectors and an expert-by-experience on the first day of the inspection. An expert by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector attended the home on the second day of the inspection.

Service and service type: This service is a ‘care home’. It provides care and support to older people, some of whom are living with dementia. 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The inspection was unannounced. The site visit activity started and on 3 June and finished on 5 June 2019.

What we did: Before the inspection we looked at all the information we had about the service. This information included statutory notifications that the provider had sent to CQC. A notification is information about important events which the service is required to send us by law. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We contacted health care professionals and the local authority quality monitoring team and asked them for their views about the service. We used this information to help inform our inspection planning.

During the inspection we looked at six people’s care records, staff recruitment and training records and records relating to the management of the home such as medicines, quality assurance checks and policies and procedures. We spoke with the registered manager, regional manager, a nurse, three care staff, the activities coordinator and the chef about how the home was being run and what it was like to work there. We spoke with four people using the service and four relatives.

Some people using the service had complex communication needs and were not able to verbally communicate their views to us, so we also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Updated 3 July 2019

About the service: Lauriston House is a care home that is registered with the CQC to accommodate up to 92 people. The home provides care and support to older people, some of whom are living with dementia. There were two units on one floor at the home. One unit had been set up specifically for people living with dementia. At the time of the inspection 24 people were using the service.

Rating at last inspection: At our last inspection on 5 November 2018 we found breaches of regulations because risks relating to people’s care and support were not always managed safely. Care plans were not reflective of people’s care needs and were not being followed by staff. Staff had not always referred people to health care services where they had identified concerns with their health. Staff had not always followed the instructions of health care professionals when supporting people. Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always deployed at the home to meet people’s care and support needs. The home relied heavily on agency staff, some of whom were not fully aware of people’s needs.

The principles of the Mental Capacity Act 2005 (MCA) had not always been adhered to where people lacked capacity to make decisions for themselves. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Staff did not always treat people with respect, or in a caring way. People were not consistently provided with a range of appropriate social activities that met their needs. We identified one incident that was a safeguarding concern which had not been properly reported or recorded. The home’s quality monitoring systems were not effective.

The home was rated inadequate overall and was placed into ‘Special Measures’.

At this inspection we saw that the registered manager and the management team had addressed these breaches and were compliant with the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Whilst we found improvements had been made in safe some areas required further improvements. The systems and processes that have been implemented in well led had not been operational for enough time for us to be sure of consistent and sustained good practice. We will look at these systems again at our next inspection of the service.

People’s experience of using this service: Risks to people using the service were assessed, reviewed and managed appropriately. People’s care and support needs were assessed before they moved into the home. They had care plans in place that reflected their needs, and these were followed by staff. Staff referred people to health care services when they identified concerns with their health. Staff followed the instructions of health care professionals when supporting people. The home had recruited more full-time staff and were no longer reliant on agency staff.

The principles of the MCA were adhered to where people lacked capacity to make decisions for themselves. Staff treated people with respect. People were provided with a range of social activities that met their needs. Safeguarding concerns were reported to the appropriate authorities when required. There were effective systems in place to assess and monitor the quality of the service.

People’s medicines were managed safely. Appropriate recruitment checks were carried out before staff started working at the home. There were procedures in place to reduce the risk of the spread of infections. Staff had received training and support relevant to people’s needs. People were supported to maintain a balanced diet.

People’s wishes relating to their end of life care needs had been discussed with them or their relatives [where appropriate] and recorded in their care files. People and their relatives [where appropriate] had been consulted about their care and support needs. The home had a complaints procedure in place.

The registered manager had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people, their relatives and staff views into account through meetings. Staff enjoyed working at the home and said they received good support from the registered manager and management team.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

As the provider has demonstrated improvements and the service is no longer rated inadequate for any of the five key questions, it is no longer in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk