CQC report explained · a residential care home
What the CQC found at Laurel Bank Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- Inspectors found suitable staffing, safe medicines management, appropriate safeguarding arrangements and a clean, well-maintained environment. Some risk assessments and as-required medicine instructions still needed updating or more personal detail.
- Effective?
- Requires improvement
- Staff were trained and people's health and nutrition needs were generally met. However, some legal authorisation conditions were not monitored as required, and care plans and mental capacity records did not always clearly show current needs or people's involvement.
- Caring?
- Good
- People appeared relaxed and comfortable. Staff were warm, respectful and attentive, promoted independence, and offered choices.
- Responsive?
- Good
- The home offered personalised support, activities, communication aids and faith services. Inspectors found good links with health and social care professionals, although some care and end of life plans lacked detail.
- Well-led?
- Requires improvement
- The home had recently changed manager and did not have a registered manager at the time. Quality monitoring and action plans were in place, but checks had not always ensured that records were updated and some staff did not feel able to express their views.
What inspectors found, January 2020
Laurel Bank Care Home was rated Requires Improvement; inspectors found safe, kind and responsive care, but gaps in records, legal checks and management remained.
Inspectors visited on 17 and 23 December 2019 without giving notice. They spoke with people living at the home, relatives, staff and health professionals. They observed care and reviewed care records, medicines records, staff files and management documents.
The home was rated Good for Safe, Caring and Responsive. Inspectors found medicines were managed safely, staffing levels were suitable, people were treated with kindness and dignity, and there were varied activities and good links with health professionals.
The home was rated Requires Improvement for Effective and Well-led. Some care records were unclear or out of date. Records did not always show people's involvement in decisions, and some conditions linked to legal authorisations had not been monitored as required. Quality checks had identified these issues, but had not always prevented them.
Kind and respectful care
People appeared comfortable with staff, who understood their communication needs and treated them with warmth and dignity.
“We observed all groups of staff interacted warmly with people. Staff knew people's communication needs well and were able to communicate effectively with them.” from the report
Safe medicines support
Medicines records and storage had improved since the previous inspection. Staff received training and competency checks.
“Staff who supported people with their medicines received regular training. Competency checks were carried out in line with good practice.” from the report
Suitable staffing and environment
Inspectors found staffing levels appropriate, prompt responses to call bells, and a spacious, clean and well-maintained home.
“Staffing levels were appropriate and regularly reviewed. Call bells were responded to promptly and we observed people received support in a relaxed manner.” from the report
Activities and social support
People could take part in group and individual activities, outings and faith services. The home employed two activity coordinators.
“Two activity coordinators were employed, and a range of creative activities were provided for people and included what they enjoyed doing.” from the report
Mental capacity records
needs fixingSome records did not show clearly enough how decisions had been made with people or their representatives. A legal authorisation condition about reviewing covert medicine had also not been monitored at the required frequency.
“Clearer and more detailed records were required when people lacked capacity to make decisions for themselves.” from the report
Care plans were not always current
needs fixingSome care plans were unclear, lacked detail or had not been updated when people's needs changed. The provider had an action plan to update them.
“Some risk assessments required updating to ensure they reflected changes in peoples' needs.” from the report
Weak quality checks
needs fixingThe home had monitoring systems, but these had not always found or prevented gaps in care records. The issues had been identified and an action plan was in place.
“Quality monitoring systems were in place, but they had not always been effective.” from the report
No registered manager
needs fixingThere was no registered manager when inspectors visited. A new manager planned to apply for registration, but leadership remained rated Requires Improvement.
“There was no registered manager at the home.” from the report
- 01What has been completed from the action plan to update care plans and risk assessments?
- 02How do you now record people's involvement in best-interest decisions and care plan reviews?
- 03How do you monitor conditions attached to Deprivation of Liberty Safeguards authorisations?
- 04Has the manager applied to register with the CQC, and who is responsible for the home until then?
- 05How do your quality checks make sure records stay accurate when people's needs change?
This was a planned, unannounced inspection covering all five CQC questions, with both the premises and care provided examined; Safe had improved since the previous inspection, while Effective had deteriorated and the other ratings were unchanged. This explanation was written from the published report of 23 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2018
Requires Improvement overall; inspectors found kind, effective care, but concerns remained about medicines, staffing and quality checks.
This was an unannounced inspection on 15 November 2018. Inspectors observed care, looked around the building, checked records and spoke with people, relatives, staff and the manager. The inspection followed concerns about medicines, records and staffing.
The home was rated Good for Effective, Caring and Responsive. People said staff were kind and attentive. Inspectors found staff were trained, people received help with healthcare and nutrition, activities were available, and complaints were handled.
The home was rated Requires Improvement for Safe and Well-led. Topical creams were not always stored safely, staffing levels had sometimes fallen below the planned level, and quality checks had missed some problems. The home had improved from Inadequate in October 2017, but remained Requires Improvement after the April 2018 inspection.
Kind and respectful care
People and relatives spoke positively about staff. Inspectors saw staff communicate warmly, protect privacy and support people with patience and compassion.
“We saw staff treated people with kindness and patience and knew people well.” from the report
Staff training and support
Staff received induction, training and formal supervision. They told inspectors the training was relevant and that they felt supported.
“Staff were well trained and supported to carry out their roles effectively.” from the report
Healthcare and nutrition
People could access a range of health professionals. Staff knew people's dietary needs, and records showed that people at nutritional risk received planned support.
“People's healthcare needs were assessed and plans of care put in place to meet their needs.” from the report
Activities and involvement
The home offered group and individual activities and adapted support for someone who had become reluctant to join in after a bereavement. People and relatives were also asked for their views.
“People were seen and heard planning the day's activities” from the report
Complaints handled
A complaints procedure was displayed and the four complaints recorded that year had been addressed.
“There had been four complaints raised this year which were all addressed.” from the report
Topical medicines
seriousSome creams and ointments were kept in bedrooms or bathrooms. This meant people living with dementia might access them without supervision.
“We found ointments and creams were not always stored safely.” from the report
Weak quality checks
needs fixingThe home's audits and checks had not found some of the problems identified by inspectors. The provider needed to make its monitoring more reliable.
“Systems had not always been operating effectively and had failed to identify and address some of the issues we found at inspection.” from the report
Care and risk records
needs fixingSome records did not give staff enough accurate or specific information. One risk assessment conflicted with a care plan, and a person who displayed challenging behaviour did not have a specific support plan.
“However, we found the assessment for one person did not reflect the care plan we saw.” from the report
Emergency evacuation plans
needs fixingPersonal emergency evacuation plans were not specific enough to tell staff and emergency services what support each person would need.
“However, the PEEPs were not specific to each person and did not give staff and emergency services all the information they would need if the building had to be evacuated.” from the report
End of life wishes
minorTwo end of life plans lacked important information about people's wishes. The home said it was working with the local hospice to improve this.
“the second persons plan did not have any detail completed.” from the report
- 01How are topical creams and ointments now stored so that people living with dementia cannot access them unsupervised?
- 02What happens when sickness leaves staffing below the planned level, and how do you make sure people still receive enough time and support?
- 03How are care plans and risk assessments checked to make sure they agree and reflect each person's current needs?
- 04Have all personal emergency evacuation plans been rewritten to give clear, individual information to staff and emergency services?
- 05How are people's end of life wishes recorded, including religious needs and other important preferences?
This was an unannounced inspection covering all five questions, the building and the care provided, prompted by concerns about medicines, documentation and staffing. This explanation was written from the published report of 28 December 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Laurel Bank Care Home
5 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- January 2020Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2018Requires improvementup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2017Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- March 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- February 2015
Report published without a new overall rating.
- September 2014
Report published without a new overall rating.
- May 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 25 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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