About the service:

¿The Laurels is a residential care service that is registered to provide accommodation, nursing and personal care for up to 41 people with the following support needs; learning disabilities or autistic spectrum disorder, physical disabilities, sensory impairments, younger adults.

¿At the time of this inspection The Laurels was providing support for 14 people.

¿ The Laurels is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. The investigation is on-going and no conclusions have yet been reached.

¿ The Laurels had been built and registered before the CQC policy for providers of learning disability or autism services ‘Registering the Right Support’ (RRS) had been published. The guidance and values included in the RRS policy advocate choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen.

¿ The Laurels requires further development to be able to deliver support for people that is consistent with the values that underpin RRS. For example, care planning processes did not always consider people’s personal information and how these informed their individual support needs and wishes, people did not always agree, review or develop their support goals and people could not always take part in meaningful activities or have regular access to the community.

People’s experience of using this service:

¿ Medicines were not always being managed safely.

¿ Risks to people were not always assessed, monitored and managed safely.

¿ Lessons were not always learnt and improvements made when things had gone wrong at the service.

¿ There were not always suitably trained staff deployed and the service did not always make sure that staff had the skills, knowledge and experience to deliver effective support.

¿People’s needs and choices were not always assessed so staff knew and understood how to deliver support for them to achieve effective outcomes.

¿Staff, teams and services did not always work together well to deliver effective support for people.

¿People did not always receive personalised care that was responsive to their individual needs.

¿Information about people’s care and treatment was not always made available in the most accessible way for people.

¿Quality assurance and governance systems were not operating effectively and were not supporting staff and management to understand their responsibilities and ensure that quality performance and risks were understood and managed.

¿ We received mixed feedback directly from people using this service.

¿ Two people we spoke with said they did not feel safe and one person raised specific concerns about unsafe staff practice. Six other people we spoke with said they liked staff, felt safe and liked living at the Laurels.

¿ Most people we spoke with said they liked staff and they were kind, however some people said staff were not always caring. Not all people we spoke with said they felt staff knew them, listened to them and respected their choices.

¿ People were aware of how to make complaints, but not all people said they received appropriate responses when they had done so.

¿ People said they were not always being offered support to take part in activities they wanted and go out of the service but that this was improving recently.

¿We have made a recommendation that the provider introduces appropriate support and accessible information for people using the service about understanding abuse and discrimination.

¿ This inspection identified continued breaches of Regulations 9, 10, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rating at last inspection:

¿ There ha

We undertook an unannounced focused inspection of The Laurels on 10 October 2018.

We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe. No urgent risks were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them.

The inspection was prompted in part by notification of an incident following which a person using the service became critically unwell. This incident is subject to a separate investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of choking, aspiration and on-going healthcare support needs for people using the service. This inspection examined those risks. We also looked to see how the service was providing enough skilled staff, preventing and learning from safety incidents, safeguarding people and operating effective quality assurance and governance systems.

The Laurels is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided.

The Laurels is registered to provide accommodation, nursing care and personal care, treatment of disease, disorder or injury and diagnostic and screening procedures. The Laurels is registered to provide this support for up to 41 people and younger adults with a learning disability or autistic spectrum disorder, physical disabilities and sensory impairments.

The Laurels is situated in a rural part of West Sussex on a self-contained complex. The service is separated into four different areas called ‘Lodges’; Juniper, Cherry, Birch and Aspen. At the time of the inspection there were 19 people living at The Laurels; 10 people in Cherry, four people in Birch and five people in Juniper. Aspen Lodge was closed and there were no people living there.

People have their own bedrooms and each Lodge had its own lounge and dining area. All people living at The Laurels also have access to a communal lounge, gym, computer room, spa-pool, swimming pool and sensory room.

The Laurels had been built and registered before Registering the Right Support (RRS) had been published. The provider had not developed the service in response to the values that underpin RRS or changes in best practice guidance for providers of learning disability and autism services. These values and guidance includes advocating choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen. We found The Laurels did not always conform to this guidance and values when supporting people or in the model, scale and geographic setting of the service. Due to this, it is unlikely that a request to register The Laurels today would be granted.

The Laurels has been without a registered manager since 10 April 2018. A registered manager is a person who has registered with the 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. The service had recruited a manager to permanently fulfil the registered manager’s role at the beginning of June 2018. The manager was in post and in the process of formally registering with the Care Quality Commission (CQC).

Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have been made.

Between May 2017 and July 2018, we have in

We undertook an unannounced focused inspection of The Laurels on 15 and 21 August 2018.

This inspection was carried out in part in response to concerns shared with us by the local authority, West Sussex County Council (WSCC) Adult Safeguarding team. These concerns related to unsafe care and risk management of specific individuals’, bowel care, nutrition, hydration, behavioural, wound management, postural support and on-going healthcare need

The inspection was also undertaken in part in response to review and analysis of information we had received about the service via our on-going monitoring and inspection processes. This information indicated that all people at the service may be at risk due to on-going unsafe management of medicines.

Following the last inspection on 20, 21 and 24 June 2018 the provider was not meeting multiple legal requirements. At this inspection we checked that improvements had been made to meet some of these requirements which related to the information of concern we had received. The requirements that we checked to see if they had improved were regarding; managing risks to people, management of medicines, deployment of suitably trained staff, preventing and learning from safety incidents, safeguarding people and operating effective governance frameworks and quality assurance systems.

We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe. No urgent risks were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them.

The Laurels is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided.

The Laurels is registered to provide accommodation, nursing care and personal care, treatment of disease, disorder or injury and diagnostic and screening procedures. The Laurels is registered to provide this support for up to 41 people and younger adults with a learning disability or autistic spectrum disorder, physical disabilities and sensory impairments.

The Laurels is situated in a rural part of West Sussex on a self-contained complex. The service is separated into four different areas called ‘Lodges’; Juniper, Cherry, Birch and Aspen. At the time of the inspection there were 19 people living at The Laurels; 10 people in Cherry, four people in Birch and five people in Juniper. Aspen Lodge was closed and there were no people living there.

People have their own bedrooms and each Lodge had its own lounge and dining area. All people living at The Laurels also have access to a communal lounge, gym, computer room, spa-pool, swimming pool and sensory room.

The Laurels had been built and registered before Registering the Right Support (RRS) had been published. The provider had not developed the service in response to the values that underpin RRS or changes in best practice guidance for providers of learning disability and autism services. These values and guidance includes advocating choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen.

We found The Laurels did not always conform to this guidance and values when supporting people or in the model, scale and geographic setting of the service. Due to this, it is unlikely that a request to register The Laurels today would be granted.

The Laurels has been without a registered manager since 10 April 2018. A registered manager is a person who has registered with the 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. The service had recruited a manager

We carried out a comprehensive inspection of The Laurels on 20, 21 and 24 June 2018. The inspection was unannounced.

The Laurels is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Laurels is registered to provide accommodation, nursing care and personal care, treatment of disease, disorder or injury and diagnostic and screening procedures. The Laurels is registered to provide this support for up to 41 people and younger adults with a learning disability or autistic spectrum disorder, physical disabilities and sensory impairments.

The Laurels is situated in a self-contained plot of private, access-controlled land in a geographically isolated rural setting. The service is separated into four different areas called ‘Lodges’; Juniper, Cherry, Birch and Aspen. At the time of the inspection there were 27 people living at The Laurels; nine people in Cherry, five people in Birch, five people in Juniper and eight people in Aspen. People have their own bedrooms and each Lodge has a self-contained lounge and dining area. All people living at The Laurels also have access to a communal lounge, gym, computer room, spa-pool, swimming pool and sensory room.

The Laurels had been built and registered before Registering the Right Support (RRS) had been published. However, the provider had not developed the service in response to the values that underpin RRS or changes in best practice guidance for providers of learning disability and autism services.

These values and guidance includes advocating choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen. We found The Laurels did not always conform to this guidance and values when supporting people or in the model, scale and geographic setting of the service. Due to this, it is unlikely that a request to register The Laurels today would be granted.

The Laurels has been without a formal registered manager since 10 April 2018. A registered manager is a person who has registered with the 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. An area manager from the organisation had been assuming the registered manager responsibilities for the service on an interim basis since then.

The service had recruited a manager to permanently fulfil the registered manager’s role at the beginning of June 2018. The manager was now in post and in the process of formally registering with the Care Quality Commission (CQC).

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. Between May 2017 and April 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

The Laurels was inspected in May 2017 and rated as ‘Requires Improvement’ overall, including a rating of ‘Inadequate’ in the Well-led section of the report. We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations, including a breach relating to ineffective quality assurance systems and failure to keep people protected from abuse and improper treatment.

At an inspection in November 2017 the rating for ‘Well-led’ had improved from ‘Inadequate’ to ‘Requires Improvement’. The service remained rated as overall ‘Requires Improvement’ and we identified a breach of regulations; The registered person had not ensur

The inspection took place on 21 and 22 February 2018. This inspection was a focused inspection brought forward due to concerns shared with the Commission from the local authority safeguarding team. The concerns were regarding how people were being supported by staff when they presented behaviours which may physically challenge staff and other people living at the home. Our inspection did not examine the specifics of these incidents and allegations. However, we used the information of concern raised by partner agencies to plan areas we would inspect and to judge the safety and quality of the service.

The service has been subject to a period of increased monitoring and support by commissioners. The service has been the subject of multiple safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation.

The Laurels was inspected in May 2017 and rated as ‘Inadequate’ in the Well-led section of the report due to breaches of Regulations. This included a breach of Regulations relating to ineffective quality assurance systems. At the last inspection in November 2017 the rating improved to Requires Improvement’ however the provider remained in breach of Regulations as further work was needed to ensure people received a consistent quality service. The provider wrote to us to tell us the action they were taking.

At this inspection we found the quality of care provided to people had deteriorated as risks to people’s health and well-being had not been managed safely. Shortly after the inspection we wrote to the provider. We informed them the Care Quality Commission was significantly concerned about some areas of care and highlighted some new potential risks for people living at the home. The provider had failed to highlight the new concerns prior to this inspection. The provider responded to us and informed us of the action they were taking to improve the quality of care they provided to people living at The Laurels.

At the last inspection we identified incidents of aggression between people had not been reported to external agencies such as the West Sussex Safeguarding Adults team. At this inspection we found people had not been consistently protected from abuse as incidents of physical aggression had not been sufficiently reviewed by the provider and had not been shared with the appropriate partner agencies. We also found staff used inappropriate forms of control and restraint when supporting people who displayed behaviours which may physically challenge others.

At the last inspection we recommended the provider review care documents written on behalf of people. At this inspection care records did not consistently demonstrate people had received the safe care and treatment as referred to in their care plans. This included for people with specific communication and behavioural needs and people who had a percutaneous endoscopic gastrostomy (PEG) feeding tubes.

At the last inspection we found systems to assess and monitor the service were not effective. Shortly after the inspection the provider wrote to us to inform us of the action they were taking. At this inspection we continued to find they were not sufficiently robust as they had not ensured a delivery of consistent, high quality care across the service or pro-actively identified all the issues we found during the inspection. This included checks made on how medicines were managed and gaps within specific staff training.

At this inspection, there was a registered manager in post who had registered with the Commission in December 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 Laurels

This was an unannounced inspection which took place on 28 and 29 November 2017.

The Laurels is a care home that provides both nursing and residential care. 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.

Since our previous inspection in May 2017, we had been made aware that following the identification of risks relating to people's care, the service had been subject to a period of increased monitoring and support by commissioners. Between December 2016 and August 2017, The Laurels has been the subject of 23 safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. Our inspection did not examine specific safeguarding allegations which have formed part of these investigations. However, we used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May and November 2017, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

The Laurels accommodates 41 people across four separate units called Birch Lodge, Juniper Lodge, Cherry Lodge and Aspen Lodge, each of which have separate adapted facilities. People who live at The Laurels may have a learning disability, physical disabilities and or sensory impairments. Some people had lived at The Laurels for many years and as such had developed needs associated with advancing age. Each unit has a separate lounge/dining room and there is also access to a communal lounge, a spa pool, a multi-sensory room, gym, computer room and swimming pool. All bedrooms are single and have their own en-suite bathing facilities. At the time of our inspection there were 29 people living at The Laurels.

The Laurels cares for people with a learning disability and therefore should be delivering care in line with the values underpinning 'Building the Right Support' and 'Registering the Right Support' guidance.

The registered manager was present during our inspection. They had not been in day to day management of the service since a new manager had been recruited and in post from 8 August 2017. The registered manager still retained oversight of the service as they were employed by the provider as an area manager with responsibility for a number of services operated by the provider including The Laurels. The new manager was also present during our inspection. They had submitted an application to register with CQC and were due to be interviewed as part of this process the same week as the inspection took 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.

We carried out an unannounced comprehensive inspection of this service on 10 May 2017 where it was awarded an overall rating of ‘Requires Improvement.’ The domains of ‘Safe’ and ‘Effective’ were rated ‘Requires Improvement,’ the domains of ‘Caring’ and ‘Responsive’ were rated ‘Good’ and the domain of ‘Well Led’ was rated ‘Inadequate.’ Four breaches of regulations were identified. These related to the management of incidents that placed people at risk of harm or abuse, quality monitoring systems and accurate records and failure to display the last CQC inspection report rating. The provider had also failed to submit statutory notifications to CQC in line with their legal responsibilities. The provider submitted an action plan that detailed the ste

The inspection took place on 10 May and was unannounced.

The Laurels provides accommodation in four units called Birch Lodge, Juniper Lodge, Cherry Lodge and Aspen Lodge, which are all on one site. The Laurels provides nursing and personal care for up to 41 people who may have learning disabilities, physical disabilities and sensory impairments. At the time of our inspection there were 36 people living at The Laurels.

People living at the service had their own bedroom and en-suite bathroom. In each unit, there was a communal lounge and separate dining room on the ground floor, where people could socialise and eat their meals if they wish. The units shared transport for access to the community and offered the use of specialist baths, spa pool, physiotherapy, weekly GP visits, 24-hour nurse support, multi-sensory room, social and recreational activities programme and a swimming pool. The service had a gym, which offered exercise equipment and had been developed by the physiotherapists employed by the provider. There was a room allocated for using computers. This was a space for people to contact their relatives through Skype, Facebook and email. The service could accommodate relatives who wished to visit their family.

The service had a registered manager but at the time of the inspection, this person was no longer managing the service on day to day basis. A home manager was appointed in January 2017 and had submitted an application to register. The service is required by a condition of its registration to have a registered manager. A registered manager is a person who 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 home manager was not available on the day of inspection. The registered manager, although regularly based at the service, was working as an area manager for the provider. Following the inspection we met with the provider who informed us the home manager had left SHC Rapkyns Group Limited. The nominated individual confirmed that the registered manager who had been promoted to area manager had returned to the Laurels as the registered manager, in day to day charge.

The inspection was bought forward as we had been made aware that following the identification of significant risks relating to people’s care, the service had been subject to a period of increased monitoring and support by commissioners. The service had been the subject of eight safeguarding investigations by social services. Following the inspection, we received assurances from the Clinical Commissioning Group (CCG) that they had also visited the service and risks relating to safeguarding concerns they were investigating had improved. They offered assurances that care plans relating to some of those people had improved and their needs were being met. However, despite these improvements and measures being in place, we identified a number of further risks, which were not appropriately managed and found four breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. At the last inspection in April 2016, the service was found to be compliant with our regulations and was given a rating of 'Good.'

Individual risks relating to people's health and welfare were not always identified and assessed to reduce those risks. Risk assessments were not always in place to provide detailed guidance to staff in how to protect people from harm. Incidents and accidents were not analysed effectively to learn lessons and reduce the likelihood of them happening again.

Staff had received safeguarding training, demonstrated an understanding of key types of abuse and explained the action they would take if they identified a

The inspection took place on 25 April 2016 and was unannounced.

The Laurels provides accommodation in four lodges called Birch Lodge, Juniper Lodge, Cherry Lodge and Aspen Lodge, which are all on one site. The Laurels provides nursing and personal care for up to 41 people who may have learning disabilities, physical disabilities and sensory impairments. There were a high number of vacancies, this was due to The Laurels being registered by CQC on 20 July 2015, at the time of our inspection there were 28 people living at The Laurels. Additional people moving in to The Laurels were going through a period of assessment and transition.

The service had a registered manager in post. 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.

People living at the service had their own bedroom and en-suite bathroom. In each lodge there is a communal lounge and separate dining room on the ground floor where people can socialise and eat their meals if they wish. The lodges share transport for access to the community and offers the use of specialist baths, spa pool, physiotherapy, weekly GP visits, 24-hour nurse support, multi-sensory room, social and recreational activities programme and a swimming pool. The service had a gym, which offered exercise equipment and had been developed by the physiotherapists employed by the provider. There was a room allocated for using computers. This was a space for people to contact their relatives through Skype, Facebook and email. The service could accommodate relatives who wished to visit their family.

People received excellent care in a way that was personalised and responsive to their changing needs. Risks to people were managed in a proactive way, which enabled them to live independent and fulfilling lives. Staff worked closely with community health professionals and therapists to maximise people's well-being. People felt safe at The Laurels and had positive and caring relationships with the staff who supported them.

The service placed a strong emphasis on meeting people's emotional well-being through the provision of meaningful social activities and opportunities. People were offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives. Visiting was unrestricted and people's relatives felt included in the care of their loved ones.

People were provided with a variety of meals and the extensive menu catered for any specialist dietary needs or preferences. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was fully respected.

People had confidence in the staff who supported them and felt safe in their care. People benefitted from sufficient staff deployed which meant that they never had to wait long for assistance. Staff treated them with kindness and took steps to promote their privacy and dignity at all times.

Staff enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training, which equipped them to deliver their roles effectively. Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the provider's required staff training was up to date. Staff told us that they felt supported and received training to enable them to understand about the needs of the people they care for. People and their relatives felt the staff had the skills and knowledge to support people well.

We saw that staff recruited had the right values,