This was an unannounced inspection that took place on 13 September 2017.

The Laurels is registered to provide accommodation, personal care and nursing care for up to 45 older people, including people living with a physical disabilities and/or dementia. The service is situated in Spondon village and is on two floors with a passenger lift for access. There is a secure garden at the rear of the premises and a patio area for most ground floor rooms.

At the time of our inspection there were 34 people using the service.

The service has a registered manager. This 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 and relatives told us the service was well-managed and provided a high standard of care. They said they had confidence in the registered manager who was approachable and helpful. They told us the care and nursing staff were kind, thoughtful and caring.

There was an established staff team and staff turnover was low with some staff having worked at the service for a number of years. This meant staff had the opportunity to get to know the people they supported well. All the staff we spoke with were knowledgeable about the people at the service, their personalities, and what was important to them.

People were encouraged to make choices about all aspects of their care and support including getting up and going to bed times, activities, personal care routines, and menu choices. Staff consulted with people and their relatives about how they wanted their care provided and ensured this was recorded in people’s care plans.

Staff knew how to keep people safe. They managed risk well by providing good quality and consistent care. The service was well-staffed. During our inspection visit call bells were answered promptly and if people needed support they didn’t have to wait for long. People had their medicines on time. Staff met people’s healthcare needs promptly and effectively and knew when to call in a doctor if they were concerned about a person’s well-being.

Staff were well-trained and had the skills and knowledge they needed to provide effective care. They understood the importance of obtaining people’s consent before carrying out care tasks and how to make decisions in their best interests where necessary.

People said the food served was good quality and the menu varied giving them plenty of choice. During our inspection visit we spent time in the dining room with some people who were having a late breakfast. There was a leisurely atmosphere. Staff asked people what they wanted and brought it to them promptly. A relative told us mealtimes were flexible as people preferred this.

People had the opportunity to take part in group and one-to-one activities. We saw one activity take place that involved throwing a soft ball onto a large bullseye on the floor. All those involved had turns and there were smiles and laughter as the activity progressed. At the end the tea trolley arrived and people had tea and biscuits. The atmosphere was lively and friendly and everyone present appeared to enjoy the activity and the socialising afterwards.

People and relatives also had the opportunity to comment on the service through completing surveys and attending meetings where activities, menus, and complaints were discussed and those present were asked for their views and suggestions. During the course of our inspection visit we saw the registered manager continually interacting with people and checking the quality of their care.

The regional manager, registered manager, and staff carried out quality audits to ensure the service was running effectively. Records showed they listened to people, relatives and staff and made improvements where necessary.

When we inspected The Laurels on 30 May 2014 we spoke with four people using the service a visitor and three staff about the cleanliness of the home. Some of the people we saw in the home had memory problems or difficulty with communicating their needs.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our inspection of 03 September 2013 we found that the provider had not ensured that all care plans and risk assessments had been completed or contained sufficient detail to meet people’s needs.

At this inspection we found the care plans and risk assessments had improved. In the sample of files that we looked at we noted there was correlation between the assistance people required and the risks surrounding that care were recognised. That meant care was detailed in the plans and risks appropriately recognised.

At our last inspection visit on 03 September 2013 the provider had failed to ensure that the recruitment files had all the information required under schedule 3 of the Health and Social Care Act 2008.

At this inspection we found that staff had not completed the audits within the timescale we agreed. That was to ensure they were aware of what recruitment information was missing and then replaced the missing items.

At our last inspection visit on 03 September 2013 the provider did not have effective systems in place to prevent, detect and control the spread of health care associated infections.

We saw the provider had introduced the cleaning schedules. However these were not as detailed as we would have expected. The forms to enable an infection control audit were in place, but none had been undertaken since our last visit. That meant people were still at risk from cross contamination and cross infection in the home.

We found care plans were written in an individual way that ensured people received personalised care and support.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We were made aware of a recent application that had been submitted. Relevant staff were aware when an application should be submitted.

Medicines were stored securely. However we saw the quality assurance processes around ensuring medicines were administered and signed for appropriately were not detailed or regular enough to highlight issues.

Staff were aware of the colour coded buckets that were used in specific areas of the home. Staff told us they were provided with personal protective equipment (PPE). We also saw plentiful supplies of PPE placed around the home. That meant staff were aware when to use equipment that reduced the possibilities of cross infection or cross contamination in the home.

Staffing numbers were not sufficient to ensure people prompt care and treatment.

Is the service effective?

People’s health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care.

Is the service caring?

We observed positive interactions between people using the service and staff throughout our time at the home. We heard positive exchanges between people whilst eating their lunch time meal. We were encouraged how staff positively engaged people and provided them with meaningful conversation.

Is the service responsive?

The staff took action to ensure a person who was not given the correct amount of medicines had not been harmed after we highlighted the issue during our visit.

Is the service well-led?

Quality assurance systems around infection control, medications and recruitment were not sufficient to ensure issues were recognised and corrected in a timely manner.

As part of this inspection we spoke with seven people who used the service, four relatives/friends and nine members of staff including the registered manager. We also spoke with a visiting health professional.

Most people we spoke with were happy with the care provided. Comments included: “I wouldn’t have stopped this long if I didn’t like it”, “brilliant” and one relative told us “it’s had its ups and downs but on the whole its pretty good”.

We found that not all risk assessments had been completed and that action had not always been taken to reduce risk.

We found that there were concerns with the cleanliness of the building. Although the provider had infection control audits we deemed these to be ineffective as they had not picked up on concerns.

Although staff members had a criminal records check, we found that the provider had not carried out sufficient pre-employment checks on staff members to ensure that they were suitable to work with vulnerable adults.

Staff we spoke with felt that staffing levels allowed them to meet people’s needs and most people who used the service that we spoke with agreed with this.

The provider had a complaints system in place. There was evidence that complaints had been investigated and action taken.

We found that people were supported by staff in choosing how to spend their days. People chose whether to join in with activities in the lounge areas or whether to remain in their bedrooms. Two people we spoke with told us they felt safe and comfortable and the staff were kind and gentle. No one spoken with raised any concerns about the care and support that they received. One person told us “I have lived here for a long time and have many friends; I would not want to live anywhere else. I am safe and loved here.” We saw that people were treated with dignity and respect. The staff team on duty were polite and respectful when offering care and support to people.

We saw that people’s capacity to make decisions about their lives was recorded in the care records. People’s support, treatment and care were detailed in their individual care plan, assessments and risk assessments. We found that people were not always receiving their medication as prescribed, which may people’s health was bring put at risk. This was because either medication was out of stock, or registered nurses had not give medication to people as prescribed.

Staff told us they received appropriate professional development and they felt equipped with the skills they needed to care for the people who used the service.

We saw there were systems in place to regularly assess and monitor the quality of service that people receive.

People who used the service told us they thought there were enough staff on duty to look after everyone. They told us care workers usually came quickly when called, but sometimes they had to wait if care workers were busy. Most people spoken with told us they did not think they waited too long for a member of staff to answer the call bell. However, one person thought they had waited too long for assistance on one occasion over a lunch time period.

People told us there were times when care workers were not available in the lounge areas. We asked people how they called for assistance and they told us they either call out or waved as a member of staff walked past.

People told us they felt safe and well looked after by the qualified nurses and care workers.

This inspection took place on the 7 and 8 July 2015 and was unannounced.

The Laurels is registered to provide accommodation, personal care and nursing care for up to 45 older people, including people living with a physical disability and dementia. There were 30 people using the service at the time of our inspection.

The service had a registered 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.

People told us they felt safe living at The Laurels. The staff team had received training on how to keep people safe from harm. Not all the relatives we spoke with felt their relative was safe, but that was because of their deteriorating health conditions which they thought made them more vulnerable, not because of how they were cared for.

Risks associated with people’s care and support had been assessed when they had first moved into the service. This was so the staff team could provide care and support in the safest possible way. Where risks had been identified, these had been regularly reviewed and all possible steps had been taken to minimise the risks to better protect people’s health and welfare.

Recruitment checks had been carried out when new members of staff had been employed. This was to check that they were suitable to work at the service. The staff team had received training relevant to their role within the service and on going support had been provided.

People received their medicines as prescribed by their doctor and medicines were being managed in line with the provider’s policies and procedures.

The staff team we spoke with told us that there were currently enough staff members on each shift to meet the current care and support needs of those they were supporting. Not all of the relatives we spoke with agreed with this. Our observations showed us that one person who used the service, who was calling for some pain relief, had to wait ten minutes before their call bell was answered. This was shared with the registered manager who said this would be looked into.

People’s consent to the care and support they were to receive had been obtained when they first moved into the service and staff involved them in making decisions on a daily basis. For people unable to give consent, decisions had been made in their best interests by someone who knew them well. The registered manager was working in line with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

People’s thoughts on the meals served at The Laurels were varied. Some people thought they were good, some people not so. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was being provided. For people assessed to be at risk of not getting the food and fluids they needed to keep them well, records had been kept showing their food and fluid intake.

People who used the service had access to the required healthcare services, were supported to maintain good health and received on going healthcare support.

Throughout our visit we observed the people who used the service being treated in a caring and considerate manner. They were involved in making choices about their care and support and when they made their choices, these were respected by the staff team.

Staff meetings and meetings for the people who used the service and their relatives were being held and surveys were being completed. This provided people with the opportunity to be involved in how the service was run.

There were systems in place to regularly check the quality and safety of the service being provided and regular checks had been carried out on the environment and on the equipment used to maintain people’s safety.