The Laurels

We identified 3 breaches of regulation relating to safe care and treatment, consent procedures, and good governance.

Governance systems were in place which identified where improvements were needed, however, we found some improvements had not been made promptly. This was partly due to the registered manager’s time being split between The Laurels and another of the providers locations. Although the provider had put systems in place to cover the management of the home in the interim, the quality of recording and review of information relevant to people’s care and safety had deteriorated. This meant there was potential for harm.

There were systems in place to assess risks to people and ways to reduce them, but these were not always regularly reviewed and kept up to date.The quality of risk assessments varied, with some risks being very well detailed whilst others were not. Records were not always accurate and complete.This was important as there were new staff working at the service who required accurate guidance to enable them to provide care which was effective and safe.Oversight of risk relating to people’s skin conditions or injuries such as bruising had not been robust. Systems in place were not being used effectively to enable the service to monitor healing or indicate how the injuries had been sustained. Where people required food prepared in a certain way to prevent choking, records did not always evidence that this had been prepared inline with their assessed needs.

Staff told us they gave people choice and helped them maintain their independence however, this was not always reflected in daily care records.Mental capacity assessments (MCA) were not always well completed to evidence that people were included in decisions about their care, and some equipment used to monitor people’s movements, such as sensor mats, did not have a corresponding MCA to ensure they were the least restrictive option. Some MCA’s were overdue review to ensure they were still relevant.

Staff received training relevant to their role,however some additional training was required to ensure staff were skilled to identify potential skin damage. We also found that although staff had been trained to manage Percutaneous Endoscopic Gastrostomy tubes (PEG) they had not had their competency assessed, as per the providers policy. This included competencies around managing people’s medicines administered via a PEG. During the inspection the registered manager sought advice from external clinicians and the PEG trainer regarding completion of competencies, which is on-going.

People received their medicines safely and as prescribed. However,there was a lack of detailed guidance for staff about the use of multiple laxatives and how long the medicines should be used before referral to a clinician.

People were supported to take part in a range of activities in the home and community. However, there was limited reference to future planning, or consideration of the longer-term aspirations of each person.

Most family members told us they were involved in developing care plans,although reviews of people’s needs had not always taken place in a timely way. People were supported to stay healthy and to access external healthcare services.People lived in a clean environment and had full access to communal areas such as a dining room, kitchen, lounge, and a sensory room.

Staff and members of the management team were observed to be kind, caring and respectful in their interactions with people. They demonstrated a good understanding of individual’s needs, preferences and routines. People had choice over personalising their rooms, and family and friends could visit at any time without prior notice.

During and following the inspection, the registered manager and deputy manager took action to begin rectifying areas which required improvement.We have asked the provider for an action plan in response to the concerns found.