This inspection took place on 9 and 14 January 2019. The first day of inspection was unannounced. We carried out this inspection to see if the provider was meeting all legal requirements.

Laurel Court 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.

We last inspected Laurel Court (Didsbury) in October 2017 when we rated the home requires improvement overall. We identified three breaches of the regulations in relation to managing risks to people, providing adequate numbers of staff and good governance. 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 now meeting the requirements in relation to these breaches.

Laurel Court is a purpose-built care home situated in the Withington area of Manchester. Accommodation for people is provided in a number of ‘households’ situated over three floors, with a further floor with rooms for training, staff use and storage. The home provides both residential and nursing care to older people and people who are living with dementia. The care home accommodates up to 91 people and at the time of this inspection the home was providing care and support for 86 people.

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 time of this inspection there was a registered manager in post at Laurel Court.

Person centred care plans and risk assessments were in place. These provided guidance and information about people’s support needs, their likes, dislikes and preferences and how to mitigate any identified risks. Staff we spoke with knew people and their needs well.

The home had effective systems for ensuring concerns about people’s safety were managed appropriately. A safe recruitment process was in place. Staff completed a thorough induction programme and regular checks were made on their development, knowledge and performance.

The service was working within the principles of the Mental Capacity Act (2005). A capacity assessment tool was used and applications made for a Deprivation of Liberty Safeguard (DoLS) if a person lacked capacity. The Care Quality Commission were informed of any authorisations granted.

New menus had been introduced but if people did not like the meals on offer alternatives were available via a snack menu. Kitchen staff were informed of people’s dietary needs and menus were shaped based on people’s preferences and choices. Residents were allowed time to eat at their own pace or received assistance and encouragement from members of staff.

An activities programme was in place. The activity coordinators carried out group activities and sessions but also devoted time for individuals who preferred one to one activities or going out in the community. People’s cultural and religious needs were being met by the service, with access to a chaplain on site.

There were policies and procedures in place around respecting equality and diversity, so that people were treated equally. People told us they felt included and not discriminated against.

The home was responsive to changes in people’s needs and any changes were documented following scheduled reviews of care or following an incident. Relatives were kept up to date with information regarding their family member.

Laurel Court had a complaints policy in place. Issues raised verbally had been recorded and responded to.

We received positive feedback about the leadership and manageme

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 trai

This unannounced inspection took place on 2 and 7 June 2016. We last inspected Laurel Court in September 2015 at which time the home was found to be non compliant in relation to Staffing and Safe Care and Treatment. The breach of Safe Care and Treatment was with regards to the safe administration of medication.

Laurel Court is in Didsbury, Manchester and is owned by Methodist Homes. It provides residential and nursing care as well as care for people living with Dementia. The home provides single occupancy rooms with en suite facilities and is registered with the Care Quality Commission (CQC)

to provide care for up to 91 people.

There are four units at the home, known internally as Wilmslow (privately funded dementia), Burton (dementia), Palatine (residential) and Broadway (general nursing). At the time of the inspection there were 78 people living at the home, across the four units.

At the time of our inspection, the home manager was not yet registered with CQC and was going through the application process. The manager had worked at the home since April 2016. 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.

People living at Laurel Court told us they felt safe. Staff we spoke with were aware of safeguarding procedures and had received training in safeguarding of vulnerable adults. We looked at recruitment records and saw that all the appropriate checks had been carried out to help ensure staff were of suitable character to work with vulnerable people. This included undertaking DBS checks and seeking two or three written references from previous employers or people of good character. The manager outlined the additional staff recruited to the service since the last inspection and the recruitment programme was on going at the time of this inspection

At the last inspection staff told us they did not think there were sufficient numbers of staff on shift to meet people’s needs in a timely way. Whilst some staff told us this was still the case this was not what we observed over the two days of inspection. We saw no one waiting for support, nor calling out for long periods of time. Call bells, when sounded, were answered in a timely way and the atmosphere on all units was calm and unhurried.

We looked at how the home ensured people received their medication safely. We saw improvements had been made since the last inspection . There were two nurses on the nursing unit dispensing medication and people received morning medicines in a timely way.

The service carried out risk assessments in relation to people’s health and care needs and measures were identified to minimise risks wherever possible. There was an viral outbreak on one of the units on the first day of inspection. Whilst the home had taken appropriate measures to contain the infection and minimise the risk of it spreading we saw that not all staff practised good infection control measures. There was also inappropriate storage of new continence products.

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 checked whether the service was working within the principles of the MCA. We found the service had completed mental capacity assessments and made best interest decisions for people when appropriate however, capacity assessments had not been decision specific. Staff had a general understanding about the MCA and DoLS, but were not completing assessments correctly. We saw the service

This unannounced inspection took place on 14 September 2015. We last inspected Laurel Court in May 2014, at which time the home was found to be meeting all standards we reviewed.

Laurel Court is in Didsbury, Manchester and is owned by Methodist Homes. It provides residential and nursing care as well as care for people living with Dementia. The home provides single occupancy rooms with en-suite facilities and is registered with the Care Quality Commission (CQC) to provide care for up to 91 people.

There are four units at the home, known internally as Wilmslow (Privately funded Dementia), Burton (Dementia), Palatine (Nursing and General Residential) and Broadway (General Nursing Unit). At the time of the inspection there were 88 people living at the home, across the four units.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Staffing and Safe Care and Treatment. The breach of Safe Care and Treatment was with regards to Safe Administration of Medication.

At the time of our inspection, the home manager was not yet registered with CQC and was going through the application process. The manager had worked at the home since November 2014. 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 staff told us they did not think there were sufficient numbers of staff on shift to meet people’s needs in a timely way. We were told this by staff working on each unit of the home. In addition some people who lived at the home told us there were not enough staff which meant they had to wait for support at times. Following the inspection, the manager sent us a ‘Staffing Guideline’ tool which described the ratios of staff required to care for people at the home on each unit. However, this did not consider peoples individual care needs and how many staff were needed as a result.

We looked at how the home ensured people received their medication safely. One person who lived on the Palatine Unit, ran out of their morning medication, which did not arrive at the home until approximately 4pm. This could have placed this person at risk. The morning medication rounds on both Palatine and Broadway did not conclude until approximately 12pm, with staff encountering interruptions on the unit at regular intervals, mainly due to having to provide support to other staff. This meant could have affected people's medication requirements later in the day and placed them at risk.

People living at Laurel Court told us they felt safe. Staff we spoke with were aware of safeguarding procedures and had received training in safeguarding of vulnerable adults. We looked at recruitment records and saw that checks had been carried out to help ensure staff were of suitable character to work with vulnerable people. This included undertaking DBS checks and seeking two written references from previous employers.

The service carried out risk assessments in relation to people’s health and care needs and measures were identified to reduce risk wherever possible.

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. The service had made DoLS applications as required. Several of the staff we spoke with felt that more in-depth training in this area would be beneficial to them.

Staff supervision was not always consistent at the home. Some of the staff we spoke with said they had not received supervision for some time. The manager told us they aimed to complete staff supervision every six to eight weeks; however the records we were shown did not demonstrate these had taken place consistently.

The staff we spoke with were able to provide examples of how they sought consent from people who lived at the home. However, on the Wilmslow Unit we observed several instances where people were not always asked for their consent before tasks were carried out by staff. We saw people were not offered the choice of refusal and were spoken to by staff as if they did not have a choice.

Two of the units at the home (Wilmslow and Burton) catered for people living with Dementia and we checked to see what adaptations had been made to make these units more ‘dementia friendly’ for people. We saw people had specific ‘memory boxes’ outside their bedrooms to remind them of past life events. However, there were few adaptations to the environment to make it dementia friendly or that would support these people to retain independence within the home. Signage around these units was limited. This meant people could have difficulty finding their way to areas such as the lounge areas, the dining room and bathrooms/toilet areas. People told us they had enough to eat and drink. We saw information was available to help ensure any special dietary requirements were catered for. There was evidence in people’s care plans that referrals were made and advice sought from other health professionals as required.

We observed staff interacting with people in a positive, respectful and friendly manner. People told us the staff were kind and caring. Staff were able to describe how they would support people to retain independence. However we observed two separate instances where people’s independence was not promoted because they did not have their walking frames close to them in order to mobilise Independently.

The service sought feedback from people using the service through surveys and resident and relatives meetings. The last minutes of a staff and relatives/residents that we were shown were from March 2015. Another residents meeting had been scheduled for the end of September 2015. The manager told us they were looking to introduce a ‘You said, we did’ system, which would clearly identify how issues that were raised had been responded to.

Activities and stimulation were limited on the day of the inspection. The only activity we saw taking place was baking which was done by the activities co-ordinator. Some of the people living at Laurel Court told us there was not always enough for them to do and staff said that due to current staffing levels at the home, they did not have sufficient time to spend with people and engage in regular conversation.

Accurate records were not always maintained by staff. These related to records for two people who were required to be weighed weekly and one person who was required to be re-positioned through the night. Although these recording systems were in place, we found inconsistencies on certain days.

A range of audits and checks were undertaken by the manager to monitor the quality and safety of the service. The manager also conducted a ‘Monthly Watch’ which consisted of observations around each unit, to ensure that good practice was prominent within the home. Some of the staff we spoke with said that they did not see the manager enough and that an increased presence on the units was required.

People and staff told us they felt able to approach the manager with any concerns. However, some staff we spoke with felt that staffing levels at the home had been a concern for some time and that nothing was being done to improve the situation.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice. There were no DoLS authorisations in place on the day of our visit.

People told us they felt safe and systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service

to continually improve.

There were appropriate arrangements in place to ensure people were kept safe within the building. Outside the building there was an enclosed garden and seating area for people to enjoy.

Is the service effective?

People's care needs were assessed by the manager and nursing staff and with their family members. People were involved in developing their own plans of care. We saw care plans reflected their current needs and we saw they were up to date.

People told us they were happy living at the home. Some comments included “I asked for a different carer to help me wash, I got a different carer the next day no fuss and no problem"

Is the service caring?

We received feedback from people using the service and their families. We asked them for their opinions about the service and the staff . All the feedback was positive and included comments like "the staff are great they know my relative well and understand their needs" "they are always happy and pleasant even though they have a difficult job sometimes". When speaking with staff and managers it was clear they genuinely cared for the people they supported. The service was person centred and took into account the diverse range of people needing support. We found the home respected people's preferences, interests and wishes and cared about the people using the service.

Is the service responsive?

People we spoke with knew how to make a complaint if they were unhappy. The service worked well with other agencies and services to make sure people received care they needed.

The manager was able to access all the information we asked for on the day of our visit in order for us to make our judgements and had responded positively by making improvements since the last Inspection. Speaking with the care staff, the chef, maintenance staff, laundry staff and domestic staff we could see each staff member wanted to perform well within their role and responded positively to questions we asked during our inspection. The maintenance staff ensured the small repairs we pointed out were done before we left.

Is the service well led?

Speaking with the manager, senior staff and the dementia lead we could see there was strong leadership within the home. They told us their emphasis was on ensuring people received a good service and were treated with dignity and respect. The dementia lead told us of the plans they had to improve the service further for people living with dementia and told us they had the support of the manager to achieve this. We could see where improvements had already been made.

Staff had a good understanding of the ethos of the organisation and quality assurance processes were in place. This helped to ensure people received a good quality service at all times. People we spoke with confirmed this and family members told us they

trusted the manager and staff and were happy with the level of support their relative received.

During our last inspection in February 2014, we observed that staff sometimes rushed to complete tasks. We raised concerns with the manager who said they would look into staffing levels on the units.

In March 2014, we received concerns that there were not enough staff to meet people's needs. It was alleged night staff were told to wake, shower, and dress a certain number of people prior to the start of the day shift.

We undertook a responsive inspection of the care home at 6:00 am on 19 March 2014 to observe how many staff were present and how these staff met people's needs.

We spoke with people who used the service. Two people spoke positively about the home. One person told us: "What I do is just wait." Although staff were busy providing personal care and preparing to handover to the day staff, we saw they were responsive to people's needs. This meant there were enough qualified, skilled and experienced staff to meet people's needs.

We found that the provider was aware of concerns about staffing and had already begun to take action by increasing the number of staff on the units, recruiting more staff, and re-deploying staff according to their skills. Staff spoke positively about these improvements. We will be following up to review the sustainability of the changes.

Laurel Court supported 91 people with nursing and personal care, including the care of people living with dementia. The home was split over four floors with each floor providing a different level of care. General nursing care was on the third floor, residential and general nursing was on the second floor, residential dementia was on the first floor and a new 12 bedded residential dementia unit had just been completed on the ground floor. We were informed an “open day” had been arranged on the day of our visit for people to see the new unit. There were currently no people living at this unit.

At the time of our visit there were 22 people living on the dementia unit on the first floor. We looked at the staffing levels to see whether they supported a quality service. We were told day time staffing consisted of a senior member of staff and four care workers. Some of the people living on the unit required the assistance of two staff. The service also employed a laundry worker, a cook, and domestic staff.

We found some of the rooms on the upstairs unit had urine soaked carpets, faeces on the wall, no appropriate bedding and little or no personal effects. In contrast the rooms downstairs in the new unit were big, bright and airy with matching carpets, curtains and bedding.

Families told us “the staff are tremendous and work diligently with compassion and a friendly attitude" which we observed during our inspection.

During the visit, we spoke with three people who use the service. They told us the staff kept them involved in the review of their care and always asked for permission before they delivered care.

The people we spoke with told us they were happy with the care they received. They told us the staff discussed their care needs with them on a regular basis.

They told us the staff were very friendly and treated them with dignity and respect. They also told us that they had no concerns about the care they received and would speak to the unit managers or the registered manager if they had any concerns.