The Laurels and The Limes Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.



At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety based on openness and honesty. Accidents and incidents were recorded and monitored by the senior management team. Regular reviews were in place to monitor people's needs, such as pressure care, falls and weights. The management team were in the process of implementing a new system to further improve their overall monitoring of accidents and incidents.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Care records were online, which could be shared between service’s where appropriate, this included a 'hospital pack' which gave a snapshot of people's needs should they require a stay in hospital. People received pre-admission assessments prior to using the service and where people were admitted to the service, appropriate checks were in place, such as an inventory of belongings and a general heath check. People were supported by external professionals and referrals were made to external professionals where required. For example, 1 person had been referred for a Speech and Language Therapy (SALT) assessment following a swallowing concern, and district nurse teams visited the service regularly.

Staff were trained and understood their responsibilities to keep people safe from the risk of harm. However, not all staff felt comfortable to report concerns to the management team. A staff member said, “I don’t feel confident things would be done if I reported a safeguarding concern.” Whilst another staff member said, “I would report anything of concern and action would be taken by the managers.” Staff told us people were safe, and people told us they felt safe living at the service. One person said, “Oh yes, I feel safe here.” And a staff member said, “I think people are safe and happy here.” Notifiable incidents were reported as required to the CQC and LA.

Staff worked in line with the principles of the Mental Capacity Act (MCA). Capacity assessments were completed for people, and where required, Deprivation of Liberty Safeguarding (DoLS) authorisations were in place.

The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Whilst we found no harm to people, improvements were required to ensure all records contained enough information, to provide staff with guidance. For example, some care plans did not contain enough detail about how staff use people's hoist slings. And some daily records did not contain enough information about how people were repositioned and what meals people had received. We also found hoist slings which were shared between people. This was brought to the attention of the managers on the day of our assessment and action taken to address this. Whilst care plans were in place and detailed people's dietary needs and we found people were given specialised diets, a kitchen record did not contain up to date information regarding people's needs. People had up to date risk assessments in place and people had equipment in place to help keep them safe from the risk of falls and pressure wounds, such as sensor and crash mats, pressure relieving cushions and air flow mattresses. Hydration stations, including snacks were in place and people had fluid jugs in their rooms, to encourage people to eat and drink.

The service did not always detect and control potential risks in the care environment. Whilst we found equipment checks were in place and appropriate risk assessments were in place to manage the risk of fire and legionnaires disease, we found some doors propped open and some equipment to be broken, such as radiator covers and a broken chair. Areas of the service looked tired and in need of redecoration. Some refurbishments had taken place since our last assessment and an ongoing refurbishment plan was in place, with a view to improving all the living spaces. People had access to call bells and where people were unable to access the call system this was recorded in care plans.

The service did not always make sure there were enough qualified, skilled and experienced staff. Most people, staff and partners told us more staff were needed. Some people told us they had to wait for support, and we saw some people waiting for staff to assist them. One person said, “There is staff, but it is like this all the time, I asked ages ago to go to the toilet, they don't always come to work on time either.” A staff member said, “I enjoy my role, and we work as a team, but there’s not enough staff, especially when people need 2 staff to support them.” A visiting professional said, “There is never enough staff. They try their best but there’s not enough of them.” People told us staff were kind and caring but were often rushed. A relative said, “The staff are great, very friendly, but there’s not enough.”

Staff were recruited safely and received an induction and regular supervisions. Pre employment checks were in place, such as previous employment references and police records checks. Clinical staff had regular checks to ensure they were fit to practice. Staff were trained in a range of subjects to support them to carry out their roles effectively and observations of staff practice were in place, such as personal care and moving and handling.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Some improvements had been made in relation to Infection, Prevention and Control (IPC) since our last assessment. For example, some new wipeable chairs were in place and new storage was in place for bathroom items and Personal Protective Equipment (PPE). However, some IPC concerns required improvement. For example, kitchen areas were visibly dirty, and some old fruit was found on a windowsill. We also found several areas of exposed wood, meaning these could not be effectively cleaned. There was a malodour to parts of the service and some shower heads required cleaning. A professional said, “The cleanliness is always poor, it smells, and it is filthy in both buildings.” We observed staff using PPE appropriately and staff were trained in relation to IPC.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines were mostly managed safely. However, we found 1 person’s medicines stock to be incorrect, this was brought to the attention of the management team on the day of our assessment, and we were assured this would be looked into. Medicine Administration Records (MAR's) were completed using an online system and staff completed these correctly. Where people received as required medicines, protocols were in place to guide staff about how and when to use these. Medicines were stored and disposed of correctly. Staff were trained and had their competency assessed prior to administering medicines to people. A staff member said, “I have had my training and had my competency assessed by the managers.”