We carried out a review of the data available to us about Lauriston on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lauriston, you can give feedback on this service.
Lauriston provides nursing and personal care for up to 60 people, some of whom lived with dementia. The home has three units over two floors. There were 36 people living in the home.
People’s experience of using this service and what we found
The provider’s governance systems had improved since the last inspection in June 2019 and systems were being used consistently to drive improvement within the service. Improvements had been made, however were still areas that needed to be further developed to ensure people's safety and well-being. For example, there was a lack of clear and accurate record keeping regarding some people's hydration support. Fluid charts were inconsistently recorded which meant that staff may not be able to monitor their health and well-being effectively. The care plans on the nursing unit need to be further developed to ensure a holistic approach.
People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. People had care plans and risk assessments which meant people’s safety and well-being was promoted and protected. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent. The home was clean, well-maintained and comfortable. There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service. Accidents and incidents were recorded and lessons learnt to prevent re-occurrences.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The home had an effective management team which provided good leadership for staff and communicated effectively with people, relatives and professionals. The management team was approachable and visible to people, staff and visitors. Staff were positive about their roles and felt valued for the work they did.
The views of people who lived at the home, their relatives and staff were encouraged and acted upon by the management team. People and their relatives felt able to raise any concerns they had and were confident these would receive an appropriate response.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 06 June 2019)
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on the 8 and 9 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led, which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lauriston on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice
Due to work force pressure the provider had made the decision not to accept new admissions at this time. This was to protect people and staff and keep them safe by mitigating risk of staff shortfalls.
The home was clean and well maintained. There was regular cleaning throughout the day, and this included high-touch areas. Cleaning schedules were in place. The head housekeeper was the infection control lead for the home and undertook checks on the cleaning and related documentation.
Following a small outbreak of COVID-19, the home had followed government guidance and was closed to non-essential visitors apart from those whose visits were essential to the health and well-being of a specific person, for example, end of life care.
Visitors were asked to wear PPE, have a lateral flow device (LFD) test on arrival or have the result of their LFD with them. They were asked to, sanitize their hands and produce their COVID-19 travel pass. This procedure was followed for all visitors to the home including health and social care professionals.
Staff supported people to remain in contact with their families by phone calls and video calls whilst restrictions were in place.
Staff were provided with adequate supplies of PPE and staff were seen to be wearing this appropriately. Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.
Regular testing for people and staff was taking place. All staff have a weekly PCR and daily lateral flow device test (LFD).
The premises has a variety of communal rooms and people who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been arranged to allow more space between people.
We found the following examples of good practice
The home was clean and well maintained. There was regular cleaning throughout the day, and this included high-touch areas. The care staff were also responsible for both the cleaning and laundry and were knowledgeable regarding current COVID-19 cleaning guidelines. Robust cleaning schedules were in place. The deputy manager and the head housekeeper were the infection control leads for the home and undertook spot checks on staff practice. The registered manager also did daily walk rounds to observe practice and support staff and people.
The premises had recently re-commenced their redecorating and refurbishment programme which had been halted due to the lockdown and outbreak. All contractors were on a COVID-19 testing programme and wore personal protective equipment (PPE).
Following an outbreak of COVID-19, the home had followed government guidance and been closed to visitors apart from those whose visits were essential to the health and well-being of a specific person: for example, end of life care. The home had just re-opened to allow one named visitor to each person following a risk assessment. These visitors were asked to wear PPE, have a lateral flow device (LFD) test on arrival or have the result of their LFD with them. They were asked to wear PPE, including a visor, sanitize their hands and have their temperature taken. This procedure was followed for all visitors to the home including health and social care professionals.
Staff supported people to remain in contact with their families by phone calls and video calls during the pandemic. Care plans included how to care and support each person during the outbreak and lockdown with specific attention to their mental well-being.
The home has just re-opened for admissions. All new arrivals to the home will only be accepted with a negative polymerase chain reaction (PCR) test and will isolate for 14 days.
There were systems in place that ensured that people who had tested positive for COVID-19 and self-isolating were cared for in their bedrooms to minimise the risk of spreading the virus. This had proved difficult for those people who lived with dementia and liked to walk with purpose, but the staffing levels had allowed for those people to have one to one support.
Staff were provided with adequate supplies of PPE and staff were seen to be wearing this appropriately. Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.
Regular testing for people and staff was taking place. There had been changes to testing following their outbreak of COVID-19 as people and staff who tested positive were not tested for 90 days as per government guidance. Routinely all staff have a weekly PCR and twice weekly lateral flow test (LFT). In addition, they have their temperatures taken daily. People have a monthly PCR test with daily temperatures and oxygen level checks.
The premises has a variety of communal rooms and people who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people.
Lauriston is a purpose built, fully adapted service registered to accommodate up to 60 people who require nursing or personal care. The service specialises in providing nursing care to older people with age related conditions, including dementia. The service is divided into four units spread over two floors, with access to the upper floor via stairs and a lift. There is a car park to the front of the building and gardens to the rear. There were 53 people living at the home at the time of the inspection.
People’s experience of using this service:
The providers’ governance systems had not consistently identified the shortfalls found at this inspection. There was a lack of clear and accurate records regarding some people's care and support. For example, wound care and pressure care management. The management of behaviours that challenge were not always documented clearly and lacked details to manage them effectively. The leadership within the service had been impacted on by the fact that there had been no registered manager for nine months and several short-term managers. We have been informed that a new manager had been recruited and would be starting employment soon and registering with the Care Quality Commission (CQC).
Risk of harm to people had not always been mitigated as good practice guidelines for the management of continence, wound care and pressure care management. There was a lack of guidance and analysis in managing some people’s behaviours that challenge and there was no evidence of what strategies worked and what staff could try next time, This meant that people's safety and welfare had not been maintained at all times.
There were sufficient staff to meet people’s individual needs, however the deployment of staff had not always ensured that peoples’ needs were met in a timely manner. Staff had passed robust recruitment procedures which ensured they were suitable for their role.
Whilst there were areas of care planning and assessing risk to people that needed to be improved, there were also systems to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, lessons were learned.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff received appropriate training and support to enable them to perform their roles effectively. Visitors told us, “The care seems really good, they seem well trained and competent,” and “I know the staff get training, I have no worries or complaints.”
People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food. Comments included, “We get choices, the food is good most of the time, it can’t be easy to please all of us.”
People and relatives told us staff were ‘kind’ and ‘caring’. They could express their views about the service and provide feedback. One person said, “I am very happy living here, the staff are nice ad friendly and very kind.”
People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families. One person told us. “I have a mobile phone and staff make sure its charged and ready in the morning, then I can ring my family if I want to.”
People's care was person-centred. The care was designed to ensure people's independence was encouraged and maintained. The dementia unit was designed to enable people who lived with dementia to walk safely and the provision of items on walls and in corridors provided stimulation and interest.
Staff supported people with their mobility and encouraged them to remain active. One visitor told us that since coming to Lauriston their relative was more mobile and confident, “They encourage people to walk, even if it’s just a short one, it gives my relative an incentive to keep moving.”
People and families were involved in their care planning as much as possible. End of life care was planned for and staff confirmed they received training.
Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists (SALT).
Notifications had been completed to inform CQC and other outside organisations when events occurred.
The service met the characteristics for a rating of Requires Improvement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: Good. (Report published on 28 October 2016.)
Why we inspected:
This inspection was brought forward due to information of risk and concern. CQC received concerns in respect of staffing level (high use of agency staff) lack of leadership and poor care delivery. The concerns raised were looked at during this inspection and have been reflected in the report.
Enforcement:
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
Lauriston is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Lauriston is a purpose built, fully adapted service registered to accommodate up to 60 people who require nursing or personal care. The service specialises in providing nursing care to older people with age related conditions, including dementia. The service is divided into four units spread over two floors, with access to the upper floor via stairs and a lift. There is a car park to the front of the building and gardens to the rear. There were 49 people living at the home at the time of the inspection. There were 17 people on the dementia unit, 17 on the nursing unit and 14 people who required support.
At the last inspection on 11 November 2016 the service was rated Good. At this inspection we found the service remained Good with requires improvement in well-led.
There were processes and procedures for monitoring the quality of care provision. However, some improvements were needed to ensure action was promptly taken when issues were identified. This was because staff had not ensured that as ‘required medicines’ were all supported by a protocol and pain chart to ensure they were used safely. This was addressed immediately. Risk assessments did not always demonstrate a framework that supported people to take everyday risks. There had been an increase in safeguarding notifications over the past eight months. These were recorded but lacked a root core analysis and follow through to demonstrate learning from these situations. Root cause analysis is a collective term that describes a wide range of approaches, tools, and techniques used to uncover causes of problems.
There were enough staff to provide safe and effective care that met people's needs. Recruitment procedures ensured staff were qualified and safe to work with people who lived in the home. Staff understood their safeguarding responsibilities and the action they should take if they were concerned a person was at risk of harm.
The provider used a variety of risk assessment tools to identify any potential risks to people's health and safety. Risk management plans guided staff on how to manage those identified risks. Daily records to support risk management were consistently and accurately completed. Accidents and incidents were recorded by staff and analysed by the deputy manager to identify any emerging trends or patterns, so appropriate action could be taken to minimise identified risks.
People received care from staff who had the knowledge, skills and competencies to support their health needs. Medicines were ordered, received, stored, administered and disposed of in accordance with good practice. Staff understood their role and responsibilities in relation to infection control and hygiene. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.
Staff supported people to eat and drink enough to maintain their health and referred people to other healthcare professionals when a need was identified. Managers and staff worked with other healthcare professionals to ensure people could remain at the home at the end of their life and receive appropriate care and treatment.
Staff were caring and compassionate. They knew people well so they could deliver care in the way people preferred and in a way that was meaningful to them. The atmosphere in the home was warm and friendly and conducive to building and maintaining relationships with others in the home as well as family and friends. People's diversity was respected and staff responded to people’s social and emotional needs in a person centred way. People told us their needs were met because they were supported and cared for in accordance with their wishes and choices.
People and staff were positive about the leadership of the service, staff and relatives felt the management team were visible and approachable.
The staff team worked in partnership with other organisations at a local and national level to make sure they were following current good practice and providing a high quality service. For example the registered provider and staff members attended regular conferences and workshops which looked at good practice.
A registered manager is 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 and associated Regulations about how the service is run.
We carried out an unannounced comprehensive inspection at Lauriston on the18 and 20 February 2015. Breaches of Regulation were found and Lauriston was rated as inadequate. A further inspection was undertaken on 30 June and 01 July 2015 to follow up on whether the required actions had been taken to address the breaches identified. We found that the breaches of regulation had been met but needed time to be embedded in to everyday care delivery and Lauriston therefore was rated as requires improvement.
This unannounced comprehensive inspection was carried out on the 14, 18 and 20 October 2016 to see if the improvements had been sustained. We found that the improvements had been sustained.
People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made.
Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, cushions were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. Staff had received training in end of life care supported by the organisations pastoral team. There were systems in place for the management of medicines and people received their medicines in a safe way.
Nurses were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The manager said care staff were being supported to do this and additional training was on-going. Food and fluid charts were completed and showed people were supported to have a nutritious diet.
Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal
lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.
A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the whole day, seven days a week and was in line with people's preferences and interests.
The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.
Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs.
All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
Staff said the management was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.
We carried out an unannounced comprehensive inspection at Lauriston on the18 and 20 February 2015. Breaches of Regulation were found. Details of previous breaches will be found under each of the five question headings. As a result we undertook an inspection on 30 June and 01 July 2015 to follow up on whether the required actions had been taken to address the previous breaches identified. We found improvements had been made and these will need to be embedded to ensure they are consistently met.
You can read a summary of our findings from both inspections below.
Comprehensive Inspection of 18 and 20 February 2015.
We inspected Lauriston on the18 and 20 February 2015. Lauriston provides nursing and personal care for up to 60 people, some of whom lived with dementia. The home had been divided in to three units over two floors. The first floor unit provided nursing care and support for 25 people with a range of illnesses, such as Parkinson’s disease, Multiple Sclerosis and strokes, some of whom were also receiving end of life care. The ground floor residential units were divided by a locked door and provided personal care and support for 15 people living with dementia and six people who were physically frail. Lauriston also provides short stay care known as respite care.
People spoke positively of the home and commented they felt safe at the home. Our own observations and the records we looked at did not always reflect the positive comments some people had made.
There was not 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.
People’s safety was being compromised in a number of areas. Staffing levels were insufficient to meet people’s individual care and social needs. Staff were under pressure to deliver care in a timely fashion and was seen to be more task orientated than person specific.
The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was not readily available on people’s preferences. End of life care lacked the holistic and inclusive approach.
Staff did not fully understand the principles of consent and therefore had not always respected people’s right to refuse consent. Not all staff working had received training on the Mental Capacity Act 2005 (MCA) and mental capacity assessments were not consistently recorded in line with legal requirements. Deprivation of Liberty Safeguards (DoLS) had not been submitted for all that required them.
People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and people responded to staff with smiles. However we also saw that many people were supported with little verbal interaction and many people spent time isolated in their room.
Activities though provided for an hour to two hours daily did not reflect people’s hobbies and interests. The dementia unit lacked the visual stimulation and dementia signage that enabled people who lived with dementia to remain independent.
Although a quality assurance framework was in place, it was ineffective. This was because it did not provide adequate oversight of the operation of the service.
Staff told us the home was not well managed at present, staff morale was low and many staff spoken with became tearful.
Training schedules confirmed staff members had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.
Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.
People’s medicines were stored safely and in line with legal regulations. People received their medicines on time and from appropriately trained senior care staff or a registered nurse.
Feedback was regularly sought from people, relatives and healthcare professionals.
Comprehensive Inspection on 30 June and 01 July 2015 .
After our inspection of 18 and 20 February 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to care and welfare, assessing and monitoring the quality of service provision, respecting and involving people and meeting people’s nutritional needs.
We undertook this unannounced inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found significant improvements had been made and they had met the breaches in the regulations.
A manager was in post and has submitted their application to CQC to be registered. Senior managers of the organisation support the manager and have time on each unit observing care delivery and fed back to the manager and staff. Staff felt that this was really positive and welcomed the feedback. One staff member said, “It means we are important to the organisation, I feel valued.” Staff confirmed there was always someone to approach with any concerns or worries.
People spoke positively of the home and commented they felt safe. Our own observations and the records we looked reflected the positive comments people made.
People were safe. Care plans reflected people’s assessed level of care needs and care delivery was person specific and holistic. Staff had received training in end of life care supported by the organisations pastoral team. The delivery of care was based on people’s preferences.
Care plans contained sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was available on people’s preferences.
Staff we spoke with understood the principles of consent and therefore respected people’s right to refuse consent. All staff working had received training on the Mental Capacity Act 2005 (MCA) and mental capacity assessments were consistently recorded in line with legal requirements. Deprivation of Liberty Safeguards (DoLS) had been submitted and there was a rolling plan of referrals in place as requested by the DoLS team.
Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutritional and hydration needs. People received a varied and nutritious diet. The provider had reviewed meals and nutritional provision with people, the chef and kitchen and care team. The dining experience was a social and enjoyable experience for people on all units.
People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.
People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and people responded to staff with smiles.
Activity provision was provided throughout the whole day and was in line with people’s preferences and interests. Staff had worked together to provide a dementia unit that was colourful, comfortable and safe. There was visual and interactive stimulation available in corridors and communal areas that people engaged with supported by attentive staff. The dementia unit now had visual signage that enabled people who lived with dementia to remain independent
Feedback had been sought from people, relatives and staff. Residents and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas. Incidents and accidents were recorded, and consistently investigated. Staff told us the home was well managed and robust communication systems were in place. These included handover sessions between each shift, regular supervision and appraisals, staff meetings, and plenty of opportunity to request advice, support, or express views or concerns. Their comments included “Really improved, I had left but now have returned, its great here now, senior staff work with us, we work as a team, really supportive manager.” Another staff member said, “Things are going well.”
We inspected Lauriston on the 18 and 20 February 2015. Lauriston provides nursing and personal care for up to 60 people, some of whom lived with dementia. The home had been divided in to three units over two floors. The first floor unit provided nursing care and support for 25 people with a range of illnesses, such as Parkinson’s disease, Multiple Sclerosis and strokes, some of whom were also receiving end of life care. The ground floor residential units were divided by a locked door and provided personal care and support for 15 people living with dementia and six people who were physically frail. Lauriston also provides short stay care known as respite care.
Accommodation and communal space was provided over the two floors with lift access that provided level access to all parts of the home. There were pleasant garden areas that were secure and safe for everyone.
Lauriston is part of a group of homes run Methodist Homes for the Aged(MHA). MHA is a charity providing care, accommodation and support services for more than 16,000 older people throughout Britain.
There has been no permanent manager in post since May 2014. 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 and associated Regulations about how the service is run. There has been four ‘stand-in’ peripatetic managers, the latest has been in post since the 23 December 2014. We were informed that a manager had been recruited and would be commencing employment on the 7 March 2015.
At the last inspection in April 2014, we found that they had met all the essential standards inspected.
People spoke positively of the home and commented they felt safe at the home. Our own observations and the records we looked at did not always reflect the positive comments some people had made.
People’s safety was being compromised in a number of areas. Staffing levels were insufficient to meet people’s individual care and social needs. Staff were under pressure to deliver care in a timely fashion and was seen to be more task orientated than person specific.
The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was not readily available on people’s preferences. End of life care lacked the holistic and inclusive approach.
Staff did not fully understand the principles of consent and therefore had not always respected people’s right to refuse consent. Not all staff working had received training on the Mental Capacity Act 2005 (MCA) and mental capacity assessments were not consistently recorded in line with legal requirements. Deprivation of Liberty Safeguards (DoLS) had not been submitted for all that required them.
People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and people responded to staff with smiles. However we also saw that many people were supported with little verbal interaction and many people spent time isolated in their room.
Activities though provided for an hour to two hours daily did not reflect people’s hobbies and interests. The dementia unit lacked the visual stimulation and dementia signage that enabled people who lived with dementia to remain independent.
Although a quality assurance framework was in place, it was ineffective. This was because it did not provide adequate oversight of the operation of the service.
Staff told us the home was not well managed at present, staff morale was low and many staff spoken with became tearful.
Training schedules confirmed staff members had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.
Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.
People’s medicines were stored safely and in line with legal regulations. People received their medicines on time and from appropriately trained senior care staff or a registered nurse.
Feedback was regularly sought from people, relatives and healthcare professionals.
Is the service safe?
We saw that people were treated with respect and dignity by the staff at Lauriston. Safeguarding policies and procedures were in place and staff understood how to safeguard the people they supported. Effective systems were in place to make sure that the manager and staff learnt from events such as accidents, incidents and investigations. This reduced the risks to people and helped the service to continually improve. 97.2% of staff had received training on the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff told us they had been trained to understand when an application should be made, and how to complete a referral. We saw that appropriate applications had been made as required and a mental health assessment completed and kept in the persons file. This provided a baseline for the monitoring of peoples mental health. This meant that people had been safeguarded as required.
Is the service effective?
People's health and care needs had been assessed on admission and reviewed monthly or more regularly if required. Families and appointees were involved in decision making where people had been assessed as not having the capacity to make informed decisions in respect of their care. The documentation evidenced that people had access to specialist health professionals when necessary, for example, speech and language therapists. People's specific dietary, mobility and equipment needs had been identified in care plans where required. The dementia wing had developed the facilities available for providing mental stimulation and promoting independence. The training programme for staff was comprehensive and this meant that the staff had the knowledge and experience to provide effective and safe care to the people they care and support. The care plan documentation had improved with the introduction of new care plan format and guidance sheets, but as detailed in the report outcome areas there were still some areas that require improvement.
Is the service caring?
People were supported by kind, attentive and qualified staff. By direct observation we saw that staff were kind and attentive whilst delivering care and support. People who were receiving end of life care were treated with respect and empathy. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We saw a comprehensive social activity programme that included one to one sessions that meant peoples social needs and mental well-being had been considered and promoted. One person told us, 'We do get the opportunity to have fun, and meet other people who live here.' Another person told us, 'I prefer to stay in my room, but they always tell me what's going on so I can attend if I want to.' One staff member told us that, 'The cinema afternoon is very popular.'
Is the service responsive?
People's needs had been assessed before they moved in to the home. This meant that the home had the skills and facilities to meet peoples' identified needs. We were told that that the regular monitoring and risk assessing of peoples' health and social needs identified when specialist input was required , such as tissue viability nurses (TVN) and dementia and community mental health services. This meant that the service was responsive to peoples' individual needs. Records confirmed people's preferences and that care and support had been provided in accordance with people's wishes. We saw evidence of learning from incidents, accidents and safeguarding investigations. Visiting health professionals told us that communication with the service had improved and that appropriate action was taken if they had any concerns.
Is the service well-led?
The service has introduced a new improved quality assurance system that is gradually being embedded into practice. Records seen by us showed that identified shortfalls were now addressed promptly. As a result the quality of the service was continuing to improve. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The training provided was comprehensive and the matrix identified that the percentage of staff undertaking training was monitored by the manager. Regular staff meetings and supervision sessions were being held, and staff told us, 'We feel supported and work well as a team,' and 'We get feedback about our performance, sometimes positive and sometimes not so good, but it means we improve our care.'
We saw that where possible people were involved in planning their care. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare.
We saw that there were sufficient qualified and experienced staff on duty to deliver the care and support required.
Staff had received the training and support necessary for them to perform their role in the home.
There was an effective complaints system available. We saw that comments and complaints people had made, had been responded to appropriately.
Staff records and other records relevant to the management of the service were accurate and fit for purpose.
We spoke to ten people during our inspection visit. We also used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people who used the service.
People told us that the home was warm and comfortable and the food was very good. We were also told that it was clean and that staff were kind and helpful.
Comments included, 'a very nice place to live', 'I'm very happy here' and 'its okay but I want to go home'.
A visitor told us that the home staff were welcoming and informative.