This inspection took place on the 22 and 24 of October 2018. The first day of the inspection was unannounced, we told the registered manager that we would be returning on the second day.

Laureston House Residential 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. The service is registered to accommodate up to 21 people. At the time of the inspection there were 18 people living there, some people were living with dementia.

At the last inspection the service was rated good. At this inspection we found that the provider had been unable to sustain this rating. The service is now rated requires improvement as we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.

There was a registered manager at the service who was supported by an assistant 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.

Risks to people were not always mitigated. This included risks associated with skin integrity and continence needs. Where people needed equipment to remain safe this was not always being used. The service was not able to demonstrate that risks from the environment had been managed. For example, the service was not able to demonstrate that the lift had been checked to ensure that it was safe before the inspection.

Medicines were not always managed safely. For example, creams and liquids were not dated when they were opened so staff would not know when they needed to be used by. Medicines were not always stored safely.

The environment did not always meet people’s needs. The decoration in of the home needed to be improved in some areas. Some areas needed some repair and there was a lack of storage which meant that some items were stored in areas used by people. One toilet door opened towards the wall and this made it difficult for people to access this room. We made a recommendation about the environment.

Care was not always person centred. There was a risk that people were socially isolated and lacking stimulation. The registered manager had organised some activities and outings but there was no activities coordinator in place and access to meaningful activities was limited. Some people spent a lot of time in their room and the service was not able to demonstrate that people were provided with social interaction. Some people told us that they were bored, and one person said that they got lonely sometimes. People had end of life care plans in place, but these had not been completed meaning that their preferences had not been recorded.

The registered manager did not always have oversight on the quality of the service. Checks on the quality of the service were not always undertaken regularly. Care plans had only been audited once. Daily contact sheets were not audited. Staff had regular supervision and appraisals and told us that they felt supported. However, medicine competency checks were not recorded. There were no checks to ensure that people were undertaking manual handling safely. There were no checks to ensure that staff that worked when the registered manager was not usually there were following safe practice. Lessons were not always learnt when things when wrong. Some incidents were not recorded so could not be analysed for trends. Following some concerns raised by a whistle-blower the local authority had made recommendations about how the service could be improved. These recommendations had not always been actioned.

People were protected from abuse. However, some staff were not able to tell us how to ide

The inspection took place on 6 December 2016 and was unannounced.

Laureston House Residential Home is a large detached house in a quiet residential area, close to Dover castle and town centre. It provides care and support for up to 21 older people some of whom are living with dementia. There were 20 people living at the service when we visited.

There was a registered manager employed at the service. The registered manager was planning to retire from the service in early 2017, so the deputy manager had been promoted to a manager role in preparation to take over from them. 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 in October 2015 we found breaches of regulations. At this inspection improvements had been made.

At the last inspection there had been a breach of regulations relating to testing water temperatures and testing for legionella. Improvements had been made and testing was now happening on a regular basis.

At the last inspection there had been a breach of regulations related to the management of medicines. People were being left with their medicines rather than staff observing that the medicine had been taken, people were being given ‘as and when required’ medicines on a regular basis and records were not being completed properly. The temperatures at which medicines were being stored was not being monitored, (if medicines are stored outside the recommended range of temperature it can affect how well they work.) Staff had changed the times of a medicine without any instruction from the doctor to do so and there had been an error in the number of doses of medicines stored.

At this inspection improvements had been made and medicines were managed safely and people were encouraged to be involved in taking their medicines. Staff stayed with people until they had taken the medicine and asked people if they would like ‘as and when required’ medicines before giving them. Temperatures were monitored and administration records were completed immediately after the person had taken their medicines. Medicine record sheets had not been altered by staff and there were the correct number of doses being stored.

At the last inspection there was a breach of regulations related to auditing the service and not identifying issues and not sharing the results of a quality audit survey. At this inspection improvements had been made. The management team had developed a new auditing system which they had completed regularly. This identified issues and showed the actions the managers had taken to resolve them. Results of quality assurance audits were now being shared.

At the last inspection there was a breach of regulations related to risk assessing how to safely move people. The risks associated with using bed rails had not always been assessed to ensure that bed rails were safe to use. At this inspection improvements had been made.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests, however some of the mental capacity assessments needed updating in case people’s capacity had changed. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS authorisations in line with the legislation.

People had care plans to identify their needs and how they preferred to be supported. Some of the care plans needed updating or would benefit from more detail. There were activities provided for people, but information about these was not displayed in an accessible way. People told us they sometimes got b

The inspection took place on 28 and 29 October 2015, and was an unannounced inspection. The previous inspection on 27 October 2013, found no breaches in the legal requirements.

The service is registered to provide accommodation and personal care to 21 older people who may also be living with dementia. At the time of this inspection there were 18 people receiving the service. The premises are on three levels, with both stairs and a lift connecting the floors. There is a large communal lounge and dining room on the ground floor and a smaller lounge in the basement.

The service has an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the inspection the registered manager was on annual leave. The deputy manager assisted the inspector throughout the inspection.

Potential risks to people were identified regarding moving and handling but full guidance on how to safely manage the associated risks were not always available. This left people at risk of not receiving the support they needed to keep them as safe as possible.

The systems in place to manage medicines were not safe. Staff had been trained but did not always demonstrate good practice in medicine administration.

People felt safe in the service. Staff signed to confirm they had read and understood the safeguarding procedures in place. They demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

Accidents and incidents had been investigated and were recorded to prevent further occurrences, however these had not been summarised to look for patterns or trends to reduce the risks of them happening again. Checks were done to ensure the premises were safe, such as fire safety checks; however water temperatures checks had not been carried out regularly to reduce the risk of scalding and to monitor the risk of legionella disease. Equipment to support people with their mobility had been serviced to ensure that it was safe to use. Plans were in place in the event of an emergency.

There was a plan in place to ensure the service was maintained on a regular basis. Some refurbishment of the premises had been carried out and plans were in place to improve the environment by December 2015. People’s rooms were personalised to their individual preferences and a new wet room had been installed.

There were enough staff on duty, to ensure that people’s needs were fully met. Staff were checked before they started to work at the service and there was an ongoing training programme to ensure that staff had the skills and competencies to carry out their roles. Systems were in place to ensure that staff received supervision and a yearly appraisal to support them in their role and identify any training and development needs. Staff were recruited safely. New staff received an induction and shadowed experienced staff until they were confident to perform their role.

People were supported to make their own decisions and choices and these were respected by staff. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The deputy manager understood when an application should be made should a person need to be assessed to have their liberty restricted. There were no DoLS applications required at the time of this inspection.

People had choices of food and specialist diets were catered for. People told us the food was good and the staff knew what they liked and disliked. The cook had daily contact with people and promoted a healthy and balanced menu so that people would remain as healthy as possible.

People were supported to maintain good health and received medical attention when required. Appropriate referrals to health care professionals were made when required.

People told us and we observed that staff treated people with kindness, encouraged their independence and responded to their needs. People and relatives told us their privacy and dignity was maintained, and the staff were polite and respectful.

People and relatives had been involved in planning their own care. Care plans had been regularly updated to ensure that staff had current information to make sure people received the care they needed. People were being supported to engage in activities of their choice. Visitors were able to visit any time and the service welcomed lots of family and friends.

People, relatives and health care professionals had been asked for their opinions on the quality of care received. The results were very positive but these had not been summarised and there was no feedback to the people so they were not aware of the outcomes. There was a system in place to record, investigate and resolve comments and complaints, however there had been no complaints in 2015. Audits and health and safety checks were regularly carried out.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.