This inspection of The Laurels Care and Nursing Home was carried out on the 31 January 2017 and was unannounced. We last visited this service on the 10 March 2016 to check whether breaches in regulation we had found during our inspection in August and September 2015 had been addressed by the provider. Whilst improvements had been made and the service was found to be no longer in breach of regulations in all areas we assessed, we could not improve the rating at that time for the service from 'requires improvement' because to do so required consistent good practice over time.

During this inspection we found evidence improvements had been consistently maintained and the service was meeting the current regulations.

The Laurels Care and Nursing Home provides accommodation and nursing and personal care for up to 28 people, most of who are living with dementia. The service is located close to the centre of Bacup and all local amenities. It is an older type grade 2 listed property with facilities on three floors. The majority of bedrooms do not have en-suite facilities although bathroom and toilet facilities are available on both floors. There are well maintained gardens and a car park for visitors. At the time of this inspection there were 18 people resident at the home.

There was a manager in post who was registered with the Care Quality Commission. A 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.

All the people, their relatives, and a visiting professional we spoke with told us the service provided a good level of care and support that placed people at the heart of their care. We found people’s rights to privacy, dignity, and freedom of choice was embedded into the culture of the home and people’s diversity was embraced.

People living in the home told us they felt safe and very well cared for. They considered staff were always available to support them when they needed any help.

Recruitment processes and procedures that were followed ensured new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively at all times.

Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. Staff was clear about their responsibilities for reporting incidents in line with local guidance and staff knew how to report any poor practice.

Risks to people’s health, welfare and safety were managed well. Risk assessments relating to people’s care were good and staff were familiar with the needs of people at risk of poor nutrition, falls, and pressure ulcers. Charts used to monitor people at risk were being used effectively.

There were appropriate arrangements in place in relation to the safe storage, receipt, administration and disposal of medicines. Staff responsible for administering medicines had been trained.

All people spoken with were very positive about staff knowledge and skills and felt their needs were being met appropriately. Staff felt confident in their roles and they were supported by the registered manager to gain further skills and qualifications relevant to their work. They were motivated and committed to provide a high quality of care.

Training was being provided to support the staff to deliver safe and effective care and support. Staff training needs was being routinely assessed and planned for and staff received regular supervision.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of b

We carried out an unannounced inspection of The laurels Care and Nursing Home on the 27 and 28 August and 1 & 2 September 2015. Breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection on 10 March 2016 to check whether the provider had followed their plan and to confirm that they were meeting 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 The Laurels Care and Nursing Home on our website at www.cqc.org.uk.

The Laurels Care and Nursing Home provides accommodation and nursing and personal care for up to 28 people, most of who are living with dementia. The service is located close to the centre of Bacup and all local amenities. It is an older type grade 2 listed property with facilities on three floors. The majority of bedrooms do not have en-suite facilities although bathroom and toilet facilities are available on both floors. There are well maintained gardens and a car park for visitors.

There was a registered manager in post at the time of our 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.

At this inspection we found that the provider had followed their plan and legal requirements were being met.

We saw evidence risk assessments had been completed to ensure people’s health, welfare and safety. Adjustments had been made to the environment as a result of these. People using the service had a personal evacuation plan which meant staff knew how to support people in the event of an emergency.

People’s care records were being maintained properly which helped determine people were receiving their care safely, consistently and appropriately. These records were audited daily by senior staff.

We saw evidence that people’s medicines were being managed properly and safely. Medicines management policies and procedures had been updated to reflect current practice and best practice guidance. Staff had received training in medicines management and their competence to administer medicines safely had been assessed. There were appropriate processes in place for the ordering, storage, administration and disposal of medicines.

Recruitment processes and procedures had improved which meant applicants applying for jobs would be properly checked to ensure their suitability.

Infection control had improved at the service. Guidance relating to infection control was available to staff. The home environment was clean and there were no unpleasant odours.

Improvements had been made to the home environment, making it more suitable for people living with dementia. Some furniture and flooring had been replaced and some areas of the home had been redecorated.

A manager had been registered with CQC.

Audits were completed in relation to many areas of the service. We saw evidence that they were effective in ensuring that appropriate levels of care and safety were achieved and the improvements required following the last inspection had been made.

Whilst improvements had been made, we could not improve the rating for the service from 'requires improvement' because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection to look at the overall quality of the service, and to provide a new rating for the service under the Care Act 2014.

We found that staff levels had been increased in order to ensure people’s needs were met. We saw that care workers were respectful and attentive to people’s needs. One person said, “Staff are smashing, I’m well looked after and there’s nothing to grumble at.”

People who were able to express their views told us that they liked living at The Laurels and were satisfied with the care provided. One person said, “The staff are great.” One visitor said, “The care is very good and the staff are nice and friendly.”

People said they enjoyed the meals and there was a choice of menu. People’s weight was monitored and when necessary advice was sought from other healthcare professionals.

We noted that procedures and training for all members of staff was in place for the prevention and control of infection.

We saw that members of staff were attentive to people’s needs. However, we observed that at lunch time there were insufficient members of staff available to serve the meal and assist people with a dementia who required help with feeding.

We found that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about the care and facilities provided at the home.

People using the service told us they liked living at The Laurels and were satisfied with the care provided. One person said, “There’s nothing to grumble at.” Another person said, “They look after us.”

We saw that people were treated with respect and leisure activities were routinely organised at the home. One visitor said, “They talk to people properly.”

We found that members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.

Members of staff told us they received the training they needed in order to provide safe and appropriate care for people using the service.

We noted that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

We carried out an unannounced inspection of The Laurels Care and Nursing Home on 27 and 28 August and 1 & 2 September 2015.

The Laurels Care and Nursing Home provides accommodation and nursing and personal care for up to 28 people, most of who are living with dementia. At the time of the inspection there were 23 people accommodated in the home.

The service is located close to the centre of Bacup and all local amenities. It is an older type grade 2 listed property with facilities on three floors. The majority of bedrooms do not have en-suite facilities although bathroom and toilet facilities are available on both floors. There are well maintained gardens and a car park for visitors.

The registration requirements for the provider stated the home should have a registered manager in place. There was no registered manager in post on the day of our inspection as the registered manager had left on the first day of our inspection visit. 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 previous inspection on 24 & 26 March and 1 April 2015 we found the service was not meeting all the regulations in respect of keeping the premises clean and free from odours, failing to make sure records were complete and accurate and failing to ensure people were protected against the risks associated with the door locking systems. The registered provider was asked to take action to make improvements. The registered provider did not send us a formal action plan. The registered provider had told us in a letter, prior to the report being published, that action had been taken to address all the breaches in regulation apart from replacement of the door locks.

Prior to this inspection visit there had been concerns raised regarding the delivery of people’s care and a number of safeguarding alerts were raised. We brought our planned inspection forward.

During this inspection visit we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe recruitment practices, quality assurance systems, maintaining accurate care records, medicines management and identifying risks to people’s safety.

At the last inspection we asked the registered provider to take action to remove the risks associated with unsuitable locking devices on people’s bedroom doors. New locks had been ordered but were unsuitable. Prior to our inspection visit the provider had to be asked to disable the existing locks as we were made aware that people were still at risk. This action has been completed and new locks were fitted following the inspection.

At the last inspection we asked the registered provider to take action to improve individual assessments of risks to people’s health and welfare. This action has been completed and risk assessments were recorded and kept under review.

We reviewed how the service managed risk. We found assessments were not available for risks such as door locks, call bells, safe fire evacuation, portable heaters, access from the corridors to the stairways and reduced access to toilets caused by the corridor ramps. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection the registered provider was asked to make improvements to the way people’s care was recorded. During this inspection we looked at people’s care charts and found gaps which made it difficult to determine whether they were receiving their care safely and appropriately. We were told new documentation was being introduced which would improve this. You can see what action we told the provider to take at the back of the full version of the report.

We looked at how the service managed people’s medicines and found deficiencies in the way they were managed. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the way new staff were recruited. We found safe and robust recruitment and selection processes had not been followed. We found suitable checks had not been completed which could place people at risk from unsuitable staff. You can see what action we told the provider to take at the back of the full version of the report.

The number of shortfalls that we found during this inspection indicated quality assurance and auditing processes had not been effective as matters needing attention had either not been recognised or had not been addressed. You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection we found a breach of regulation because the registered provider had failed to ensure parts of the home were clean and free from odours. During this inspection we found whilst some areas of the home were clean and odour free we found others that remained malodourous. The local authority infection control lead nurse visited the home during our inspection. We were told she had no immediate concerns. We made a recommendation that the service followed advice and guidance regarding infection and prevention control practices.

Prior to our inspection the local authority safeguarding team told us they had concerns about people being left unattended. During this inspection we observed there were sufficient staff to meet people’s needs but we had concerns about how staff were deployed and the lack of leadership and direction they received. However, following our initial visit the registered provider had provided appropriate management cover and had appointed a manager. In addition we found staff were working more effectively as a team, were available in all areas of the home and were responding to people’s needs and requests in a timely way.

During our visit we observed staff talking gently and calmly to people to try to resolve difficult situations. There were clear instructions recorded to guide staff with dealing with behaviours that challenged the service. However, not all staff had received training in this area which would help to keep themselves and others safe. We made a recommendation that the service provided staff with appropriate training to safely support people with behaviours that challenged the service.

We found most staff had received a range of appropriate induction, supervision and training to give them the necessary skills and knowledge to help them look after people properly. However there were a number of gaps in the training record and it was difficult to determine whether bank and agency staff had received appropriate induction and training.

People told us they enjoyed the meals and said they were offered meal choices and alternatives to the menu were provided. We saw people being sensitively supported and encouraged to eat their meals.

Staff had an understanding of abuse and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered. We observed people being asked to give their consent to care and treatment by staff.

At our last inspection we found some areas of the environment were in need of improvement. During this inspection we looked at all areas of the home. We found some areas were well maintained whilst other were still in need of improvement. We also noted the environment was not well designed for people living with dementia. However, there was a development plan that included areas for improvement within appropriate timescales.

People told us they were happy with their bedrooms. Some had created a homely environment with personal effects such as furniture, photographs, pictures and ornaments. We made recommendations that the service obtained guidance and advice regarding providing a suitable and interesting environment for people living with a dementia and that they complied with the dates on the improvement plan.

Records showed the service had good links with other health care professionals and specialists to help make sure people received prompt, co-ordinated and effective care. A visiting healthcare professional told us staff kept them up to date with any changes to people’s health, would contact them for advice and would follow any recommendations made. Another healthcare professional told us they had no concerns about the care provided at the home.

During our visits we observed staff responding to people in a caring and considerate manner and staff taking time to sit and listen to people. Some people were able to make choices and were involved in decisions about their day. We heard staff speaking to people in a respectful way and saw people were dressed smartly and appropriately in suitable clothing of their choice.

People who used the service and their relatives were encouraged to discuss any concerns during meetings and day to day discussions with staff and management and also as part of the annual customer satisfaction survey. Records had been maintained of people’s concerns and records showed the service had responded in line with procedures. We were told people’s concerns and complaints were monitored to help improve the service.

There were systems in place to seek people’s views and opinions about the running of the home. People’s views were taken into consideration and there was evidence changes had been made as a result of this to areas such as the provision of activities and the display of complaints guidance.

Before a person moved into the home a detailed assessment was carried out about their needs. People were able to visit the home and meet with staff and other people who used the service before making any decision to move in.

Each person had a care plan that was personal to them which included information and specific instructions about the care and support they needed and wanted. Information had been improved since our last inspection. The care plans had been updated by staff regularly and in line with any changing needs. Records showed some people living in the home, or their relatives, had been involved in decisions about their care. However, we made a recommendation the service should seek guidance in relation to the recording of and management of Do Not Attempt Resuscitation (DNAR) orders.

There was an activities person who was responsible for the provision of daily activities. Activities provided included games, the use of memory boxes, shopping, films, gardening, church services, hand and nail care, one to one sessions, reading and arts and crafts. People told us they were able to keep in contact with families and friends. Visitors told us they were made to feel welcome.