This inspection took place on 04 and 06 February 2019. The first day was unannounced. The service was last inspected on the 16, 17 and 23 April 2018. The registered provider did not meet the requirements of the regulations during that inspection as multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to safeguarding people from abuse, staffing, and good governance. Additionally, we found a breach to Regulation 18 of the Care Quality Commission Registration Regulations as the registered provider had failed to notify the Care Quality Commission, (CQC) of all reportable incidents.

At this inspection visit carried out in February 2019, we found the registered provider had worked hard to make improvements but not all required improvements had been made.

Laurel Bank is a purpose-built home, registered to provide accommodation for up to people who require nursing or personal care. Accommodation is provided for up to 67 people. All bedrooms are en-suite and are located on two floors, served by a passenger lift. There are two double rooms available for those who wish to share facilities. At the time of the inspection visit 43 people were receiving care and support at the home.

Laurel Bank 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.

At the time of the inspection visit 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. 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. We used this inspection visit to ensure all amendments had been made. We found some, but not all improvements had been made.

At this inspection visit carried out in February 2019, we found paperwork was not consistently accurate, complete and readily available. This was a continued breach of Regulation 17 of the Health and Social Care Act (2008) Regulated Activities 2014, Good Governance.

Additionally, we identified good practice guidance had not been consistently implemented to ensure the safe management of medicines. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014, Safe Care and Treatment.

Auditing systems had been reviewed to ensure audits carried out reflected what was happening at the home so action plans could be developed and maintained. Oversight at the home from senior managers had increased to ensure the service was well-led. Lessons had been learned from the previous inspection visit.

People, relatives and staff told us they had seen an improvement in how the home had been managed since the new management team had been appointed following the last inspection visit.

We found deployment of staffing had improved. Work had been carried out with the staff team to ensure staff responded in a timely manner. When people made requests for assistance we saw their needs were promptly addressed. People who lived at the home spoke highly of the staff and their attitude. We noted staff were patient and respectful with people.

A new call bell system had been fitted within the home which could monitor and record call bell response times. Additionally, the new registered manager had reviewed how staff were deployed in line with the staffing calculator on each unit. Although improvements had been made we noted there was only one call bell alarm in each lounge. We have made a recommendation about thi

This unannounced inspection took place on 16, 17 and 23 April 2018.

Laurel Bank is a purpose built nursing home situated close to the city centre of Lancaster. Accommodation is provided for up to 67 people needing assistance with personal or nursing care. All bedrooms are ensuite and are located on two floors, served by a passenger lift. At the time of the inspection visit 48 people were receiving care and support at the home.

Laurel Bank 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.

At the time of the inspection visit there was no registered manager in place. The registered manager had de-registered with the Care Quality Commission in November 2017. 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 provider had nominated a member of staff to undertake the role of acting general manager in the absence of the registered manager.

Laurel Bank was last inspected April 2016 and was overall rated as good. At this inspection visit carried out in April 2018, we found the registered provider was not meeting the required standards.

People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, processes were not always followed to ensure safeguarding concerns were consistently reported to the local authority safeguarding team for review. This meant systems to ensure people were safe from abuse were not consistently followed. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safeguarding service users from abuse and improper treatment).

We found staffing levels and deployment of staffing was not always effective to ensure the safe care of people. People and relatives told us they frequently had to wait for staff to attend to their needs.. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We looked at records maintained by the service. We noted records were not always fully complete and up to date. For example, accident and incident reports did not always include completed body maps to show injuries sustained.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

During the inspection visit we reviewed the auditing systems established and operated by the registered provider. We found auditing systems were sometimes ineffective and had not always identified concerns we identified during the inspection process. For example, a monthly audit had failed to identify a safeguarding incident had occurred and had not been responded to appropriately. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

There was lack of oversight at the home to ensure regulatory responsibilities were met. During the inspection visit we identified five incidents which the CQC had not been told of. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009.

Recruitment processes for ensuring staff were suitably qualified to work with people who may be vulnerable were not consistently applied. We have made a recommendation about this.

Arrangements were in place for managing and administering medicines. However these were not always consistently carried out to ensure good practice guidelines were followed. We have made a recommend

The inspection visit at Laurel Bank was undertaken on 18 and 19 February 2016 and was unannounced.

Laurel Bank is a purpose built nursing home situated close to the city centre of Lancaster. At the time of our inspection visit there were 56 people who lived at the home. People who live at Laurel Bank are older people, younger adults and may have a physical disability. All bedrooms are en suite and are located on two units, served by a passenger lift. There are two double rooms available for those who wish to share facilities. Amenities are within easy reach, such as shops, pubs, library, cafes, museums, leisure facilities and public transport links.

The service had a registered manager in place. 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 inspection on 05 November 2013, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, staff responsible for assisting people with their medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and appropriate arrangements for storing medicines were in place.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure. One person told us, “I am quite safe with the staff, they are very good.”

The provider had recruitment and selection procedures in place to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Comments we received demonstrated people were satisfied with the care they received. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care.

A complaints procedure was available and people we spoke with said they knew how to complain. Staff spoken with felt the registered manager was accessible, supportive and approachable and would listen and act on concerns raised.

The registered manager had sought feedback from people who lived at the home and staff. They had formally consulted with people they supported and their relatives for input on how the service could continually improve. The registered manager had regularly completed a range of audits to maintain people’s safety and welfare.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service.

We spoke with sixteen people who lived at the home, five relatives and four members of the staff team. We observed the care and support people received, and spent time with people in the communal lounges of the home and over lunch.

There appeared to be a friendly and welcoming atmosphere within the home. One person told us, “You don’t have to get up if you do not want to, like some places. They will bring my meal and stay with me to make sure I do not choke. You have got your own freedom.” A second person told us, “It is much better than my last place, I could not get out of quick enough. My personal care is dignified and respectful.”

One relative we spoke with told us they were happy with the care and support provided, “If it`s a nice day and we want to go out they give us blankets, nothing is too much trouble. You never feel if you ask for something there is any hesitation.” A second relative told us, “We looked at three places; this one had good reports from friends.”

Our discussions with staff confirmed they were aware of their responsibilities and what actions to take if they suspected someone was at risk of harm or abuse. People we spoke with told us they felt safe.

We looked at the staffing rotas over a four week period and they showed us there was sufficient staff on duty with a range of skills and experience to meet the needs of the people who lived at the home. Staff were supported with training and personal development.

There were a range of audits and systems in place to monitor the quality of the service being provided.

People told us they were consulted and were involved in decision making about their care and support. All the people we talked with were very positive about the way staff treated them. They told us they were treated with respect and dignity. They said they were happy with their care and the staff were responsive to their needs. We observed throughout our inspection that people were treated with sensitively and patiently. Some of the comments we received were:

“Of course we can do what we want it’s our home isn’t it?”

“I have a lot of good friends here and we help each other”.

“When they come to get you up they ask you if you would like a bit of a lie in and then come back when you want to get up”.

“They encourage you to be self reliant but they will still do anything for you if you ask”.

One person confirmed that they were happy with the arrangements in place for them to manage some of their own medcines and had everything they needed.

We were able to chat with a good percentage of people living at the home, who in general, provided us with positive feedback about what life was like at Laurel Bank.

Comments received from residents and their relatives included:

"I like going to the cinema in Lancaster. I go with my daughter whenever a film appeals to me. I am going there this afternoon to watch the new film about Margaret Thatcher."

"We have entertainment in the evenings sometimes. A theatre company came last week. They were absolutely hilarious."

"The staff are very caring. My dignity is always respected when they are doing anything for me, like taking me to the toilet or giving me a bath."

"I am very outspoken and I would deffinitely say if anything was not right, but all I can say is that the staff are all lovely. They are really dedicated to their jobs and looking after us."

"The needs of my relative are always met. The nursing care is always provided with the upmost dignity and respect. I cannot fault Laurel Bank at all"

"I think the staff here are marvelous. They are patient and extremely kind to people. They work very hard. I am quite happy my relative is in Laurel Bank."