This inspection took place on the 5 of November 2018 and was unannounced. Lauriston House 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. Lauriston House accommodates up to 39 people in one adapted building. There were 30 people living at the service at the time of our inspection. At our last inspection on 29 and 31 August 2017 the service was rated ‘good’.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found breaches of regulations 9, 10, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Risks relating to people’s care and support were not always managed safely. Care plans were not reflective of people’s care needs and were not being followed by staff. Staff had not always referred people to health care services where they had identified concerns with their health. Staff had not always followed the instructions of health care professionals when supporting people. Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always deployed at the home to meet people’s care and support needs. The home relied heavily on agency staff, some of whom were not fully aware of people’s needs.

The principles of the Mental Capacity Act 2005 (MCA) had not always been adhered to where people lacked capacity to make decisions for themselves. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Staff did not always treat people with respect, or in a caring way. People were not consistently provided with a range of appropriate social activities that met their needs. We identified one incident that was a safeguarding concern which had not been properly reported or recorded. The home’s quality monitoring systems were not effective.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There were safe systems in place for storing and administering medicines, and for monitoring controlled drugs. However, the daily medicine audits and balance checks required improvement because they were not always accurate. Robust recruitment checks were carried out before staff were employed to work at the home. The provider had infection control policies and procedures in place which provided staff with guidance on how prevent or minimise the spread of infections. Staff received training relevant to people’s care and support needs. They told us they had regular training which had enabled them to perform their role efficiently.

People’s privacy was respected. Staff received training on equality and diversity, and they supported people according to their diverse needs. People knew how to complain if they needed to. Information was available to people in different formats which met their needs. None of the people living at the home required immediate support with end-of-life care. The service worked with health care professionals in providing end-of-life support to people when required. The provider sought the views of people and their relatives through surveys and meetings. They had acted on some of the suggestio

This inspection took place on 29 and 31 August 2017 and was unannounced. Lauriston House provides residential and nursing care for up to 39 older people most of whom are living with dementia. At the time of our inspection there were 33 people using the service.

The home did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The previous registered manager left employment in April 2017. The current manager had been working at the home for four weeks at the time of this inspection. They demonstrated good knowledge of people’s needs and the needs of the staffing team. They were in the process of applying to the CQC to become the registered manager for the home.

At our last inspection of the home on 2 and 4 August 2016 we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in that there was a lack of activities provided to people that met their needs and preferences. During this inspection we found that people were being provided with a range of activities that met their needs.

There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Procedures were in place to support people where risks to their health and care needs had been identified. There were safe staff recruitment practices in place. Medicines were managed, administered and stored safely.

The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they received supervision and training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People’s privacy was respected. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. People received appropriate end of life care and support when required. Care plans and risk assessments provided guidance for staff on how to support people with their needs. People and their relatives were aware of the home’s complaints procedure and records showed that complaints were responded to appropriately.

There were appropriate arrangements in place for monitoring the quality and safety of the service that people received. The provider took into account the views of people using the service through residents and relatives meetings and satisfaction surveys. The provider carried out unannounced visits to the home to make sure people where receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from their colleagues and the manager.

We carried out an inspection of this service on 17 and 19 February 2016 following concerns we received in relation to the care delivery and the management of the service. We found breaches of regulations in that medicines were not safely managed, staffing levels were not appropriate to meet the needs of people at the home. Systems and processes in place for auditing medicines were not robust in identifying issues to improve on the quality of the service. The provider complaints policy had not been followed in all cases to ensure that complaints and concerns raised were addressed appropriately. The providers monitoring checks were not effective in identifying the concerns we found at our inspection. Records were not always kept to demonstrate that the care delivery was in line with the care and treatment planned for.

Following the inspection we served a warning notice on the provider and registered manager requiring them to comply with the regulations. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 02 and 04 August 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements.

At this inspection we found that the service was now compliant with the regulations that had been previously breached. However there was one new breach identified because of a lack of activities designed to meet people’s needs and preferences.

The home did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was in the process of recruiting a permanent manager. At the time of our inspection there was an interim manager in place at the home.

Lauriston House provides residential and nurse care for up to 39 older people most of whom are living with dementia. At the time of our inspection there were 33 people using the service.

Staff training required improvement to ensure that staff were up to date with training courses to meet people’s needs at the home.

Medicines were managed effectively. Regular medicine audits were conducted. Staff had completed medicines training and the home had a clear medicines policy in place which was accessible to staff. The home maintained adequate staffing levels to support people in the home. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. Staff demonstrated an understanding of types of abuse to look out for and knew how to raise safeguarding concerns. Risks to people using the service were assessed reviewed, recorded and managed appropriately.

We saw friendly, caring and supportive interactions between staff and people using the service and staff knew about peoples the needs and preferences. Care plans were person centred and regularly reviewed.

Staff received regular supervisions and these were scheduled across the year. Staff were safely recruited with necessary pre-employment checks carried out.

People’s capacity and rights to make decisions about their care and treatment where appropriate were assessed in line with the Mental Capacity Act 2005 (MCA 2005).

People were provided with sufficient amounts of nutritional food and drink to meet their needs. People were consulted about menu choices and supported to maintain a balanced diet.. People were supported to maintain good health and have access to healthcare services.

Concerns and complaints were investigated and responded to in a timely and appropriate manner. There was evidence of medicines and overall compliance audits and issues identified were actioned promptly. The manager was accessible to people, and staff spoke positi

We carried out an unannounced comprehensive inspection of this service on 02 and 03 June 2015. Following that inspection we received concerns in relation to the care delivery and the management of the service. As a result we undertook a focused inspection on 15 and 18 March 2016 to look into those concerns. This report only covers our findings in relation those topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lauriston House on our website at www.cqc.org.uk. As the comprehensive inspection took place more than six months before the current inspection, we have not revised the overall rating for this service.

Lauriston House provides nursing and personal care for up to 39 people, some of whom have dementia. At the time of this inspection the home was providing nursing care and support to 35 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s medicines were not managed safely. Appropriate information was not always available for the safe management of medicines and systems were not always in place for the safe recording of people’s medicines. Staff training and competency assessments were not completed for all staff to ensure they had the appropriate skills and knowledge for the safe management of medicines. Medicines errors had not been identified and reported promptly. Systems and processes in place for auditing medicines were not robust in identifying issues to improve on the quality of the service.

CQC is currently considering appropriate regulatory responses to address these breaches in legal requirements. We will report on this at a later date.

Staffing levels were not always appropriate to meet people’s needs in a timely manner. The provider had a complaints policy in place however this had not been followed in all cases to ensure that complaints and concerns raised were address appropriately. The provider had monitoring checks in place but these were not effective in identifying the concerns we found at our inspection. Records were not always kept to demonstrate that the care delivery was in line with the care and treatment planned for.

We found that some other areas required improvement. Each person using the service had a care and treatment plan in place which included guidance on how they should be cared for; however relatives felt more could be done to meet people’s personal care needs. The provider had a part-time activities coordinator in post however people and their relatives told us there was not enough to do at the home. There were systems in place to monitor the safety of the premises and equipment used within the home; however this required improvement because faulty equipment was impacting on the care delivery.

People told us they felt safe living at Lauriston House Nursing Home and we found that the provider had safeguarding adults and whistleblowing policies in place and staff were aware of action to take to protect people in their care. There were safe recruitment protocols in place. Assessments were undertaken to identify the level of risk to people and appropriate actions were in place to prevent or mitigate these risks.

This inspection took place on 2 and 3 June 2015 and was unannounced. This was our first inspection of the registered provider at this location.

Lauriston House provides nursing and personal care for up to 39 people, some of whom have dementia. At the time of this inspection the home was providing nursing care and support to 35 people. 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.

People using the service said they felt safe and that staff treated them well. Safeguarding adults procedures were robust and staff understood how to safeguard the people they supported. People’s medicines were managed appropriately and they received their medicines as prescribed by health care professionals. The manager demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). There were enough staff to meet people’s needs. Appropriate recruitment checks took place before staff started work.

People and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. People were being supported to have a balanced diet.

There were residents and relatives meetings where people were able to talk to the manager about the home and things that were important to them. The provider took into account the views of people using the service and their relatives through surveys. The results were analysed and action was taken to make improvements for people at the home. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

Staff said they enjoyed working at the home. They received appropriate training and good support from the manager. There was a whistle-blowing procedure available and staff said they would use it if they needed to. The provider monitored the quality of care and support that people received. Unannounced spot checks were carried out by the manager to make sure people received good quality care at all times.