Archived: The Laurels

Updated 5 June 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection took place on 17 and 18 November 2020. The inspection team consisted of two adult social care inspectors and a medicine inspector.

On 17 November 2020 all three inspectors carried out an inspection visit to the service. On 18 November 2020 two adult social care inspectors visited the service. Following the site visits all three members of the inspection team reviewed care records and spoke with staff and relatives remotely.

Service and service type

The Laurels 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.

At the time of the inspection, the service had a manager registered with the Care Quality Commission. The registered manager had been absent from managing the service for over 28 consecutive days. The service had two other managers from within their organisation running the service while the registered manager was away.

On 7 December 2020 the manager de-registered with the CQC. This means the provider now has sole legal responsibility for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced on the day of our first site visit on 17 November 2020. When we announced the inspection, we worked with the provider to agree the safest way to inspect during the Covid-19 pandemic to minimise the risks to people who live at the service, staff and our inspection team.

What we did before the inspection

Before the inspection, we reviewed information we held about the service. We considered the information which had been shared with us since the last inspection by the provider as well as the local authority, other agencies and health and social care professionals.

During the inspection

We spoke with both managers overseeing the service, the clinical lead, registered nurses (RGN) and various support staff. We spoke with the chief operations officer and the director of quality. The director of quality is also the provider’s nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed people’s care and medicine records. We spent time talking to and observing people being supported, including during lunch. We visited some people’s bedrooms.

After the inspection

We reviewed copies of people’s care and medicine records, training records, rotas, incident reports and quality assurance records. We spoke with the managers and clinical lead, an RGN, two support workers and four relatives of people using the service via telephone.

Updated 5 June 2021

The Laurels is a residential care service that is registered to provide accommodation, nursing and personal care for people with learning disabilities or autistic spectrum disorder, physical disabilities, and younger adults.

The service was registered for the support of up to 41 people. At the time of the inspection nine people were using the service.

The service consisted of four separate Lodges within one building. At the time of the inspection, all nine people were living in one lodge. Two people from these eight were staying with relatives, so there were seven people staying in the lodge when we visited.

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.

People’s experience of using this service and what we found.

There was unsafe assessment, monitoring and management of risk for people with support needs regarding constipation, behaviours that may challenge, choking, breathing, skin integrity, mobility and posture.

Risks around people’s deteriorating health and well-being were inconsistently managed and monitored by staff.

Medicines were not always managed safely. People had not always received their medicines as intended when they needed them.

People were not always safeguarded from abuse.

Lessons were not always learnt, and actions not taken to investigate safety incidents, and prevent them re-occurring.

Staff practice, and reporting systems to safeguard people from abuse, were not always effective to ensure people were safe from harm.

Staff did not always have the required competencies or knowledge to safely meet people’s individual needs.

Service management, and the provider’s wider quality assurance and governance systems, had not always ensured actions were taken to address any issues and risks in a timely manner. People’s care records were not always up to date or accurate.

The provider had failed to act upon known areas of concern, non-compliance, and risk to improve the quality of care for people at The Laurels. This had exposed people to on-going poor care and risk of avoidable harm.

Staff told us they had not always worn the correct personal preventative equipment (PPE) when supporting people. The provider acted immediately to address this with staff and offer additional training and guidance. The provider had ensured there were adequate stocks and supplies of PPE available.

The provider had acted to manage other infection risks during the Covid-19 pandemic. Additional infection prevention and control measures in line with Department of Health and Social care guidelines had been put in place to ensure people’s safety.

Staff had alerted appropriate external agencies when they had displayed signs and symptoms of Covid-19. This had helped prevent infection and maintain people’s health and well-being.

Relatives told us the service was always clean and well maintained whenever they had visited, or from what they had seen on video calls.

We observed there was a high ratio of staff supporting people during the inspection. Staff and people said there were currently enough staff. Relatives told us they thought staffing levels had improved and more staff had been recruited recently.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting did not maximise people’s choice, control and

independence.

The service was in private grounds in the countryside. Opportunities for people to access the local community were limited. Staff wore uniforms and name badges to say they were care staff when coming and going with people.

The service is bigger than most domestic style properties. There were identifying signs on the road before the service’s private drive, the service grounds and on the exterior of the service to indicate it was a care home.

Right care:

Care was not always person-centred or promoted people’s dignity, privacy and human rights.

People were not supported safely.

People were not always listened to.

Staff did not always respond in a compassionate or appropriate way when people experienced pain or distress.

Right culture:

The management team had begun to plan how to work to ensure they could provide good quality personalised, respectful support for people living at the service.

People had recently been allocated keyworkers, to help them get the support they needed and wanted.

Staff said they were being encouraged to understand how to support people in a person-centred way.

We observed staff supporting some people in a positive manner during our inspection visits

However, significant work was still needed to change the existing culture, ethos, attitude and practice of staff at The Laurels in order to achieve this vision.

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 Inadequate (published 9 July 2020). The service has been rated requires improvement or inadequate for the last eight consecutive inspections.

At the last inspection we found multiple breaches of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We carried out a comprehensive inspection on 20 and 21 August 2019 and an announced targeted inspection on 19 May 2020. Breaches of legal requirements were found at both inspections.

We undertook this focused inspection to confirm the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. 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 The Laurels on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations 12, 13, 17, 18 in relation to: safe care and treatment, safeguarding people from abuse, good governance and staffing.

We have also identified a breach of Care Quality Commission (Registration) Regulations 2009 regulations 14 and 18 in relation to failing to notify CQC of incidents regarding staffing, abuse or allegations of abuse in relation to service users and of the absence of a registered manager.

We took enforcement action to issue a Notice of Decision to vary a condition of the provider's registration

and remove this location. The Laurels is now de-registered and the provider is no longer able to provide regulated activities at or from this location.

Follow up

We will continue to monitor information we receive about the service until we return to visit. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.