This inspection took place on 30 and 31 October 2017 and was unannounced. Laurel Court (Didsbury) 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.
Laurel Court (Didsbury) accommodates up to 91 people in one adapted building. At the time of our inspection there were 85 people living at the home. The home provides both residential and nursing care to older people and people who are living with dementia. Accommodation is provided across four floors, which are referred to as ‘households’. The ground and first floors provide residential care to people living with dementia. The second floor provides general residential care, and the third floor provides nursing care for up to 20 people, with two places for people receiving residential care. The provider had decreased the number of beds they allocated for nursing care since our last inspection.
We last inspected Laurel Court (Didsbury) in June 2016 when we rated the home requires improvement overall, and identified one breach of the regulations in relation to managing the risks relating to infection control. Following the last inspection we asked the provider for an action plan to tell us how they would make improvements to meet the requirements of the regulations. We found the provider had followed their action plan and was meeting the requirements in relation to this breach.
At this inspection we identified breaches of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the assessment and management of risk to people’s health and wellbeing, providing adequate numbers of staff and good governance. You can see what actions we have told the provider to take at the back of the full version of this report.
People living at Laurel Court were generally satisfied with the care they received and they spoke positively about the caring nature of staff. However, we also received consistent reports from people living at the home and staff members that there were not sufficient numbers of staff on duty. This had a direct impact on the ability of staff to deliver person-centred care, and people commented that there could be delays in receiving support to eat meals or being assisted to get up in the mornings.
Staff had assessed risks to people’s health and wellbeing. However we found two instances where risk assessments had been completed incorrectly, which had the potential to impact on the safety of the care people received.
Staff recorded any accidents or incidents that occurred, and we saw there were robust processes in place to help the registered manager monitor the incidence of any accidents, incidents, weight loss or other factors that might put a person at risk of harm. We saw appropriate actions had been taken in response to any concerns, such as putting in place appropriate equipment including falls monitors. Staff had also made referrals to specialists such as physiotherapists, dieticians or speech and language therapists where further input or advice was needed.
Medicines were managed safely. We saw they were stored securely and that staff had the information they needed to enable them to administer medicines safely.
We observed most areas of the home to be clean and tidy. However, carpets and furniture in the ground floor household were heavily stained. The registered manager had updated an action plan they had received following an amber RAG (red, amber, green) rating from an audit by the community infection control team in June 2017. Most actions had been completed, and the registered manager told us the final actions would be completed as part of a forthcoming refurbishment.
Staff had completed training in a variety of topics relevant to their job roles. However, we found they had only received basic training in dementia care. There had been adaptations to the environment to make it more ‘dementia friendly’ on the households that provided support to people living with dementia.
We received mixed, but generally positive comments in relation to the food provided. However, staffing levels meant people were not always supported to receive their meals at the times they preferred.
Staff were aware of the principles of the Metal Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), and the provider had made DoLS referrals to the local authority as required. Where people lacked capacity to make decisions themselves, we saw staff had recorded best interest decisions in most cases. However, we found a number of people’s bedroom doors were locked when they were sat in the lounge, which staff told us was at the request of relatives. There was no evidence this potentially restrictive practice had been considered in relation to best interests and there was no record relating to this practice in people’s care files or DoLS applications.
The registered manager told us that use of agency staff had decreased, which was confirmed by people we spoke with living at the home. People told us they had developed positive relationships with staff members, and we saw people were comfortable in the presence of staff. People told us staff respected their privacy and treated them with respect. Staff involved people in their care as far as was possible.
Care plans were detailed and contained the information staff needed to meet people’s needs in accordance with their preferences. Care plans had been reviewed monthly, and staff were aware of people preferences and needs as detailed in the records.
The home had been without an activity co-ordinator for several months, which had affected the provision of activities. However, a new activity co-ordinator had started the same week as our inspection, and the chaplain employed by the home also supported activities, including a poetry group and church service. We saw activities provided by external groups taking place during the inspection, such as an exercise and music group.
The home had a registered manager 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.
The registered manager told us they were well supported by the provider. People living at the home told us the registered manager was approachable, and that they felt comfortable approaching them with any concerns they might have.
The provider had an extensive range of audits and quality assurance checks to help monitor the safety and quality of the service. We found the provider had acted on feedback from relevant persons to make improvements to the service. However, these systems had not ensured the provider was meeting the requirements of the regulations or that the home improved its CQC performance rating from requires improvement.