About the service:

Laburnum Court is part of Four Seasons (Bamford) Limited and situated in a residential area of Salford. The home provides nursing care as well as care for people living with dementia. The home provides single occupancy rooms, across two units, which are known internally as 'The Lowry' and ‘The Priory’. At the time of the inspection there were 55 people living at Laburnum Court.

People’s experience of using this service:

People told us they received their medicines when required and raised no concerns, however we identified some issues with the management of topical medicines, such as creams.

People and their relatives spoke positively about the standard of care provided and the caring nature of the staff. People told us they would recommend the home to others and described it as ‘homely’ with a ‘lovely atmosphere’.

Staff had received safeguarding training and knew how to identify and report any concerns. Accidents, incidents and falls had been documented consistently, with audits completed to look for trends and help prevent a reoccurrence. We found the home to be clean throughout with effective cleaning and infection control processes in place.

Staff had received sufficient training and ongoing support to help them carry out their roles. People described the staff as being kind, friendly and despite being very busy, ‘always managing to smile’.

People received personalised care which met their needs. Care files contained personalised information about the people who lived at the home and how they wished to be supported and cared for. These had been reviewed regularly to reflect people’s changing needs and wishes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were encouraged to remain as independent as possible, with lots of positive examples of this noted during the inspection.

People spoke positively about the choice and standard of meals provided and we found people requiring a modified diet received these in line with professional guidance, albeit we have recommended the provider considers how this is documented, to better evidence compliance.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Action plans had been completed to promote continuous improvement.

For more details please see the full report either below or on the CQC website at www.cqc.org.uk

Rating at last inspection:

At our last inspection the home was rated as requires improvement (report published April 2018).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. As the home was rated as ‘requires improvement’ following our last inspection, we returned within 12 months to check the necessary improvements had been made.

Follow up:

We will continue to monitor information and intelligence we receive about the home to ensure care remains safe and of good quality. We will return to re-inspect in line with our inspection timescales for good services, however if any information of concern is received, we may inspect sooner.

We carried out an unannounced inspection of Laburnum Court Care Home on 07 February 2018. We made a second announced visit on 09 February 2018 to complete the inspection.

The inspection was carried out in response to concerns we had been made aware of, which related to the care and treatment provided to a person who resided at the home. The concerns indicated potential issues with training and the management of risk in the home, especially in relation to manual and person handling practices. While we did not look at the circumstances of the specific incident, which is subject to a local authority safeguarding investigation, we did look at associated risks.

The home was last inspected on 12 and 14 June 2016, when we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to safe care and treatment and meeting nutritional and hydration needs. Following this inspection the

home was rated as requires improvement overall and in the key lines of enquiry (KLOE's); safe, effective and well-led. The home was rated as good in caring and responsive.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; safe, effective and well-led to at least good. We reviewed the progress the provider had made as part of this inspection.

At this inspection we identified four breaches in three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the management of medicines, manual handling procedures, following dietetic guidance and maintaining accurate and contemporaneous records. You can see what actions we told the provider to take at the end of the full version of this report.

Laburnum Court 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.

Laburnum Court is part of Four Seasons (Bamford) Limited and situated in a residential area of Salford. The home provides nursing care as well as care for people living with dementia. The home provides single occupancy rooms, across two units, which are known internally as 'Lowry' which provides nursing care for people living with dementia and 'Priory', nursing care. At the time of the inspection there were 57 people living at the home.

There was not a registered manager in post at the time of this inspection, as the previous registered manager had resigned. A home manager had been appointed and was in the process of completing their registration. 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.

We found some improvements in medicines management had been made since the last inspection and noted a number of examples of good practice; however we also identified concerns with stock rotation and control, management of covert medicines and guidance for as required (PRN) medicines.

We saw evidence of referrals being made when staff identified issues with either swallowing or weight loss, however found that action plans provided by professionals, specifically dieticians had not been implemented consistently, which meant some people had not received the required fortification of their diets. We also identified issues with the completion of food and fluid charts, which meant it was not always possible to confirm people had drank the recommended about during a 24 hour period.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed

This comprehensive inspection was unannounced and took place on 12 June 2017. We made a second announced visit on 14 June 2017.

At our comprehensive inspection on 03 November 2015, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to governance. Following this inspection the home was rated as requires improvement overall and in the key lines of enquiry (KLOE’s); responsive and well-led. The home was rated as good in safe, effective and caring.

We then undertook a focused inspection in March 2016 and found the provider was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to good governance. A warning notice was issued and a time frame indicated to be compliant with the legal requirements.

A further focused inspection was conducted June 2016 and the provider was found to be compliant with the regulations but the home remained requires improvement. We could not improve the rating in 'well-led' from requires improvement at that time, because to do so we require evidence of

consistent good practice over time.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to safe care and treatment and meeting nutritional and hydration needs. You can see what we action we took at the end of the full version of this report.

Laburnum Court is part of Four Seasons (Bamford) Limited and situated in a residential area of Salford. The home provides nursing care as well as care for people living with dementia. The home provides single occupancy rooms, across two units, which are known internally as ‘Lowry’ which provides nursing care for people living with dementia and ‘Priory’, nursing care. At the time of the inspection there were 64 people living at the home.

There was a registered manager in post at time of this inspection. 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.

Most people using the service provided positive feedback regarding the service received. People told us they felt safe and said staff were kind and caring.

There were mixed views on whether there were enough staff and we have made a recommendation regarding this.

We found concerns regarding how the service was operated as people had been placed at risk of harm. We found prescribed medicines were not managed safely. Following GP reviews, we found there had been delays in actioning medicine changes. The provider could not demonstrate sufficient time was maintained between doses, covert medicine protocols required strengthening and stock procedures required review. We gave feedback following our inspection visit on 12 June 2017 and by our second visit 14 June 2017, action had been taken to address the issues identified.

We also raised concerns regarding the management of people’s nutritional and hydration needs as there was missing information to guide staff to meet people’s needs safely and we found ambiguity between documentation in regards to what people’s assessed needs were.

The home had suitable safeguarding procedures in place and staff were able to demonstrate that they knew how to safeguard people from harm. A high number of altercations had occurred between residents on ‘Lowry’ and the provider was looking in to environmental changes to address this.

Robust employment checks had been conducted before new staff commenced employment in the home.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate induction, training, supervision and appraisal to support them in their role.

People were supported in line with

This unannounced focused Inspection was undertaken on the 16 June 2016.

Laburnum Court provides nursing and personal care. It is one of 43 locations registered under the provider, Four Seasons (Bamford) Limited. The home has a dedicated unit for dementia care on the ground floor called ‘The Lowry.’ On the first floor the service has a nursing and personal care unit, which is called ‘The Priory.’ The home is situated in a residential area of Salford.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Laburnum Court Care Home on our website at www.cqc.org.uk.

At our last two inspections, on 03 November 2015 and 14 March 2016, we found that the provider had failed to maintain accurate and complete contemporaneous records for people who used the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. As a result we issued a warning notice, which told the provider they must take action to improve record keeping at the home. During this inspection, we found the home was now meeting the requirements of regulations in respect of record keeping.

As part of this inspection we looked at six care files of people who had used the service. Care records provided guidance to staff about people’s care and treatments needs. We found that records were now up to date and accurate. A ‘My choices Booklet,’ which provided detailed person centred information about the individual who used the service, were were now complete. Written consent had now been obtained from people who used their service or their representatives. Where consent had not been obtained, the home had documented efforts made to contact relatives or representatives to obtain the appropriate consent. We found accurate records of weights were recorded, which were reviewed by the service on a weekly and monthly basis.

In advance of our inspection we also received information of concern about the way the service managed complaints. We looked at the service policy and the home’s record of complaints received and action taken to address concerns. We found two instances, where complaints had not been dealt with in line with the home’s policy. On the whole, we found complaints were dealt with in line with the home’s policy and in a timely manor.

This unannounced focused Inspection was undertaken on the 14 March 2016.

Laburnum Court provides nursing and personal care. It is one of 43 locations registered under the provider, Four Seasons (Bamford) Limited. The home has a dedicated unit for dementia care on the ground floor called ‘The Lowry.’ On the first floor the service has a nursing and personal care unit, which is called ‘The Priory.’ The home is situated in a residential area of Salford.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Laburnum Court Care Home on our website at www.cqc.org.uk.

During our last inspection on 03 November 2015, we found that the provider had failed to maintain accurate and complete contemporaneous records for people who used the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. We found care files were very cumbersome and not sequential in presentation order. A number of care plans were incomplete and lacked up to date information, such as people’s weights and there were instances where reviews had not been documented. A number of care plans did not contain any written consent for the care and treatment provided. We also found that records did not accurately represent people’s health needs.

As part of this inspection we looked at 12 care files about people who had used the service. The service had introduced new documentation and the quality of care files generally had improved. Care records provided guidance to staff about people’s care and treatments needs. However, in each file we looked at there was a ‘My Choices Booklet.’ This had the potential to provide very detailed person centred information about the individual who used the service. In each care file we looked at, the ‘My Choices Booklet’ had not been completed. Additionally, written consent had not been consistently obtained in respect of photographs and care plan agreements.

This continues to be breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. We found the service failed to maintain accurate and complete contemporaneous records for people who used the service.

In advance of our inspection we also received information of concern about the service, informing us that the home was not maintaining high standards of cleanliness. As part of this inspection, we checked the standards of cleanliness and working practices at Laburnum Court Care Home in respect of infection control and prevention.

We visited both the dedicated unit for dementia care on the ground floor called ‘The Lowry,’ and the nursing and personal care unit, which is called ‘The Priory, situated on the first floor. We found evidence that staff were using both gloves and aprons when delivering personal care and at meal times. We found glove and apron dispenser units were well stocked. We saw that hand hygiene facilities were available in communal toilets, bathrooms and in people’s bedrooms.

During our visit, we observed domestic cleaners present throughout the home. The home was clean without any unpleasant smells. We observed lunch on both units and observed that staff were suitably dressed and protected when supporting people. Dirty dishes and food were not left unsupervised and removed at the earliest opportunity. We saw staff regularly washing their hands during this period. This helped reduce the spread o

This was an unannounced inspection carried out on the 03 November 2015.

Laburnum Court provides nursing and personal care. It is one of 43 locations registered under the provider, Four Seasons (Bamford) Limited. The home has a dedicated unit for dementia care on the ground floor called ‘The Lowry.’ On the first floor the service has a nursing and personal care unit, which is called ‘The Priory.’ The home is situated in a residential area of Salford.

At the time of our visit, the current home manager was in the process of registering with the Care Quality Commission as the registered manager. 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.

At the last comprehensive inspection carried out in January 2015, we found that the registered person had not protected people from the risks associated with infection control, because the service had not maintained appropriate standards of cleanliness and hygiene. Following a further focused inspection carried out in July 2015, we found that the service was then meeting the requirements of regulations.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3). You can see what action we told the provider to take at the back of the full version of this report.

We found care files were very cumbersome and not sequential in their presentation order. A number of care plans were incomplete and lacked up to date information, such as people’s weights. We found instances where reviews had not been documented. A number of care plans did not contain any written consent for the care and treatment provided.

We found one care plan that did not accurately represent skin integrity issues for a person who used the service. We found a pressure sore had been recorded as a grade one sore, however, following our review it transpired the pressure sore should have been graded as a grade two sore. We also found that a duplicate care file had been created for one person who used the service.

This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), good governance, because the service had failed to maintain accurate and complete contemporaneous records for people who used the service.

People living at Laburnum Court Care Home and their relatives consistently told us that they or their loved ones were safe living at the home.

On the notice board in the main reception area, we saw illustrations and pictures representing safeguarding and what action to take. Contact details of the local safeguarding team were also displayed together with service's ‘whistleblowing’ policy and procedures.

As part of the inspection we checked to see how the service managed and administered medication safely. On the whole, we found people were protected against the risks associated with medicines, because the provider had appropriate arrangements in place to manage medicines safely.

We found there were sufficient numbers of staff on duty during the day to support people who used the service.

Staff confirmed they received regular training in subjects such as safeguarding, first aid and the Mental Capacity Act, which we confirmed by viewing the training records.

People had access to healthcare professionals to make sure they received effective treatment to meet their specific needs.

We looked at a sample of 15 care files and found that individual nutritional needs were assessed and planned for by the home. We saw evidence that nutritional and hydration risk assessments had been undertaken by the service.

Everyone we spoke with thought the staff were kind and caring.

As part of the inspection we checked to see that people living at the home were treated with privacy, dignity and respect. People who used the service told us that their dignity and privacy was always respected.

People and relatives told us they were involved in making decisions about their care and were listened to by the service.

Though people told us that they were involved in determining the care their loved one’s received, this was not clearly documented in their care plans.

During the inspection, we saw several examples of where staff at the home had been responsive to people’s needs. For example where people were required to be weighed weekly or monthly, there were records to suggest this had taken place.

We found the provider had effective systems in place to record, respond to and investigate any complaints made about the service. The complaints procedures were on display in the reception area.

Since our last inspection in January 2015, we noted a number of improvements had been made by the service to address our concerns at that time. This included a new management structure involving the appointment of a new manager, supported by a deputy manager and clinical lead. All staff we spoke with commented on the positive changes made to the service following the appointment of the new manager.

We found the service undertook a comprehensive range of audits and checks to monitor the quality of services provided.

We looked at how the service learnt from any incidents, complaints or safeguarding matters. The service demonstrated to us where lessons had been learnt, what immediate action had been taken and where action plans had been put in place to address deficiencies.

Providers are required by law to notify CQC of certain events in the service such as serious injuries, deaths and deprivation of liberty safeguard applications. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.

We carried out an unannounced comprehensive inspection of this service on 07 January 2015. During that inspection we found one breach of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. After that inspection, the provider wrote to us to tell us what action they had taken to meet legal requirements in relation to the breach of regulation.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Laburnum Court Care Home on our website at www.cqc.org.uk.

This inspection was undertaken on 03 July 2015 and was unannounced. We found the provider had made improvements and was now meeting the requirements in relation to the breach of regulation we had found.

Laburnum Court provides nursing and personal care. It is one of 43 locations registered under the provider, Four Seasons (Bamford) Limited. The home has a dedicated unit for dementia care on the ground floor called ‘The Lowry.’ On the first floor the service has a nursing and personal care unit, which is called ‘The Priory.’ The home is situated in a residential area of Salford. There was a manager in place who was currently in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At our last inspection we found that the registered person had not protected people from the risks associated with infection control, because the service had not maintained appropriate standards of cleanliness and hygiene. During that inspection we found vulnerable people were exposed to the risk of infection as the service had not ensured cleaning had been undertaken in a timely manner. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which related to standards of cleanliness and infection control.

During this inspection we found the provider was now meeting the requirements of the regulation. Together with the manager we walked around the home and did not notice any unpleasant odours and found both private and communal areas to be clean. Corridors were bright and clear of obstruction. We found that most carpets had been replaced and where carpets remained, these were due to be replaced imminently. We checked bedding, mattresses and bathing facilities without noting any concerns. Staff appeared well organised and motivated. We also looked at cleaning schedules and audits undertaken by the manager to monitor cleanliness throughout the home.

This unannounced inspection was carried out on the 7 January 2015.

Laburnum Court provides nursing and personal care. The home has a dedicated unit for dementia care on the ground floor called The Priory. On the first floor there is a nursing and personal care unit called The Lowry. The home can accommodate a maximum of 68 people. At the time of our visit, there were 31 people being supported on the Priory Unit and 37 people on the Lowry Unit.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At the last inspection carried out in July 2013, we did not identify concerns with the care provided to people who lived at the home.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

At 10.15am we went into the dining room on the Priory Unit where some of the residents were finishing their breakfast. We observed a considerable amount of debris on the floor which had not been cleaned up at this stage. When we returned to the dining room at 12.30pm, when lunch was being served, we observed the floor was still dirty and now included a liquid spillage which had not been cleaned up.

We spoke to a health care professional who was visiting the home during our inspection. They raised concerns about a strong unpleasant odour in one bedroom and stained and dirty carpets in another room.

We observed staff assisting during lunch time at the Priory Unit. We did not observe staff washing their hands or wearing gloves before commencing serving. We saw two members of staff who used their finger and a fork to place food on plates when serving meals. We also observed one staff member blow on a person’s food to cool it down. One visiting relative told us; “I have seen staff serve food with their fingers.”

This is a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, people were at risk to infection because the service did not maintain appropriate standards of cleanliness and hygiene. You can see what action we told the provider to take at the back of the full version of this report.

Relatives of people who used the service told us they believed their loved ones were safe at Laburnum Court Care Home. One visiting relative we spoke with told us; “My X is absolutely safe. I feel staff know my X very well and because I’m here often, I have witnessed very personalised attention to her needs.”

During our inspection we checked to see how the home protected people against abuse. We found suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. The notice board in the main reception area contained safeguarding information using illustrations as well as words, which made it clear to understand. It also described what action to take if people had any concerns.

On the whole, throughout the home, we felt there were adequate numbers of staff on duty during most of the day. However, we observed at peak periods during the day such as when medication rounds were undertaken on the Priory Unit and meal times throughout the home, that there were insufficient staffing levels to effectively meet people's needs.

We looked at how the service managed people’s medicines and found the arrangements were safe.

Staff explained they had undertaken a comprehensive induction before commencing their role, which included a period of shadowing more experienced staff and that their progress was regularly reviewed over a three month period.

The home was part of the Pearl Project, which was developed in January 2008 by the provider as a specialised approach to dementia services. The home had implemented an action plan over 12 months, which was on-going to address a number of areas affecting people with dementia that included; the environment, training and a person centred approach.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We saw there were procedures in place to guide staff on when a DoLS application should be made. The home maintained a record of all applications submitted and the current status.

We found meal times were very task orientated and not a pleasurable experience for people who used the service. In one dining room, we found people had to wait long periods of time before being served with their meal, several residents were fast asleep and snoring by the time their food was served.

There did not appear to be any clear strategy for dealing with the numbers of people waiting for their lunch. The deployment of staff appeared to be random and uncoordinated and not consistent with people having a pleasurable experience.

Visiting relatives told us they found staff to be very caring. One visiting relatives told us; “First and foremost, I cannot praise the carers enough.” People were able to approach staff and have a positive experience. The ease with which this occurred indicated staff that understood the needs of the people in their care.

The home was part of the North West End of Life Care Programme known as Six Steps to Success. Several members of staff had received training in this end of life care programme which enabled people to have a comfortable, dignified and pain free death.

We found no set activity programme in the home on the day of our inspection or very little in the way of mental or physical stimulation for people. On the day of our visit, a hairdresser was in attendance in the hairdressing salon. Loud jolly music was being played and people were clearly enjoying the experience. The room was a beehive of activity throughout the day. However, people not having their hair done were just left with the television switched on in the lounge with no other options of things to do.

We have made a recommendation about ensuring people had opportunities to take part in activities.

The registered manager was present throughout our inspection together with the regional manager. We discussed our concerns together where improvements were required, specifically relating to the absence of clear leadership on both units during our visits in relation to the deployment and coordination of staff. Staff deployment was random and uncoordinated, which had resulted in a lack of any coordinated activity by staff without a clear sense of priorities in relation to meal times and cleaning duties.

The service held regular relatives meetings to listen and learn from people’s experience with the service. We looked at minutes from these meetings which included topic such as food and dining. The manager held an open surgery every Thursday between 2pm and 4pm which was an opportunity for relatives to pop in and raise any issues or concerns. However, several visiting relatives we spoke to expressed frustration that requests and suggestions to improve the service were not always listened to.

Both people visiting the home and staff told us that the home maintained a positive culture which was open and inclusive. On visiting relative said “We have no worries here, If we saw anything we didn’t like we would soon tell them and the manager.” Another relative told us; “If I had any concerns or complaints, I would immediately speak to the Manager as I know the matter will be dealt with which gives you confidence.”

We spoke with nine people who used the service, five staff members, a visiting professional and the manager during the course of our inspection. We observed that people's care was generally unhurried and that people with dementia care needs were supported to make choices during the day. Where people were unable to comment, peoples family members told us they were happy with the care their relative received. One person told us, "My relative has come on leaps and bounds here".

People told us they were happy with the amount of information staff gave them about their care. There were systems in place to support people who lacked capacity to make decisions for themselves.

There were enough qualified, skilled and experienced staff to meet people’s needs. Copies of recent staff rotas showed that levels of staffing were consistent. From observing staff interactions we saw people felt safe and comfortable with the staff. One person told us; “The staff are good, they quite regularly pop in and have a chat with me. I never feel alone for too long”.

The provider had systems in place to monitor the quality of the service provided. Where shortfalls were identified a plan was made to address these.

People's personal records were accurate, fit for purpose and held securely.

This review took place to check the provider had made improvements in relation to some concerns we identified at a previous inspection. People using the service generally gave us positive feedback about the service and about the care they received at Laburnum Court. Some people using the service had complex needs which meant they were not able to tell us their experiences.

During this visit we spoke with six people living at the home, two people’s relatives, three members of staff and the manager. Their comments included: “They are always trying to help us." "The staff are kind."

We saw that staff were polite and friendly. Staff approached people in a gentle and sensitive way explaining what they were doing and why.

We were told relatives were involved in decision making around care planning and in the reviews of their care.

People told us they were involved with the assessments that were carried out before they went to live at Laburnum Court. People who were able to comment were generally satisfied with the care provided at Laburnum Court. Relatives we spoke with believed their relatives were generally being cared for well and had their needs met.

People were seen to receive regular medical care from the general practitioners who visited the home regularly.

People told us the staff were "on the whole kind and friendly" and "a great bunch."

Some of the people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this we used a formal way to observe people to help us understand how their needs were supported. This is called the Short Observational Framework for Inspection (SOFI). Some of these observations have been included in this report.

For part of this inspection we were supported by an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of service. This person talked with a number of people who use the service at Laburnum Court care centre. The Expert by Experience completed a report after the inspection and some of their comments and observations are included in this report.