Archived: Laurel Bank

Updated 3 May 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This focussed inspection took place on 20 March 2017 and was unannounced. The inspection was carried out by three inspectors. The team inspected the service against one of the five questions we ask about services: is the service safe. This is because we had received information of concern which related to the safety of the service.

Before the inspection we reviewed the information we held about the home. This included looking at information we had received about the service and statutory notifications we had received from the home. We also contacted the local authority commissioning and safeguarding teams and the clinical commissioning group (CCG).

We spoke with four people who were living at the home, two relatives, three care workers, the kitchen assistant, a nurse, the deputy manager, the registered manager and the provider.

We looked at ten people’s care records, medicine records and records relating to the management of the service. We looked round the building and saw people’s bedrooms and the communal areas.

Updated 3 May 2017

We carried out an unannounced comprehensive inspection of this service on 7 and 10 February 2017 and found breaches of regulation.

On 17 March 2017 we received information of concern following visits made to the service by the Clinical Commissioning Group (CCG). The concerns related to risk management in terms of monitoring people’s weights, ensuring adequate nutrition and hydration and people being nursed continually in bed when there was no clinical reason why they could not get up. As a result we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Laurel Bank on our website at www.cqc.org.uk.

We inspected the service on 20 March 2017. The inspection was unannounced.

Laurel Bank provides accommodation and nursing care for up to 37 older people. The property is a converted house which has been extended. Accommodation is spread over two floors and includes single and shared rooms. There are a variety of communal areas including lounges, a dining room and an enclosed garden. There were 24 people using the service when we visited.

The home has a registered manager who has been in post for many years. 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.

Many of the issues we identified at the inspection as detailed below, were raised at our inspection in February 2017 and have not been resolved by the provider.

We found people’s nutritional needs were not being met. Records showed people had lost significant amounts of weight or had been of very low weight for several months, yet no action had been taken by nursing staff to explore this and steps had not been taken to boost people’s calorie intake to help them gain weight. There was no evidence to show weighing equipment had been calibrated to make sure it was recording accurately. The last calibration date for one set of scales was 2013. Although the CCG had identified issues with the weighing scales and had asked for people to be re-weighed, we saw only 16 out of 24 people had been re-weighed.

Food and fluid charts were poorly completed, there was no evidence to show people were receiving regular snacks. Where people were having their fluid intake monitored there was no record to show the daily target intake and when we asked staff how much fluid people should be having they said they didn’t know. There was no evidence to show nurses were reviewing the food and fluid charts and the deputy manager acknowledged this wasn’t done. We saw charts which showed people had received very little to eat and drink, yet this had not been picked up or acted upon by the nursing staff. We saw some people were being nursed in bed and were not getting up on a regular basis.

Some people were having thickening agents added to their drinks. For two people the thickeners were not prescribed on the MARs. There was not always information recorded to show how much thickener people should be having in their drinks and when we asked staff they were not clear with some telling us everybody had one scoop per 200mls and others said they gave two scoops per 200mls.

We saw Personal Emergency Evacuation Plans (PEEPs) had not been updated and some people had changed rooms and this was not reflected in the PEEP. This meant in an emergency the fire brigade would not have the correct information if they needed to evacuate people. We found weekly fire alarm tests had not been completed since 1 March 2017.

There were ongoing problems with the hot water supply and many bedrooms had no hot water. Staff told us they had to fetch hot water from the kitchen to take to people’s bedrooms so people could have a wash. Although plumbers were on site trying to fix this issue staff we spoke with said there had been problems with the hot water for a long time. In one occupied bedroom we found there was a leak from the ceiling into the room.

Following the inspection a safeguarding meeting took place with the provider and an immediate protection plan was agreed and enacted which ensured people in the home were safe and received the care they required.

The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service remains in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.