OSJCT Longlands

OSJCT Longlands is a residential care home providing accommodation and personal care to up to 48 people. The service provides support to older people, some who are living with dementia, in one adapted building. At the time of our inspection there were 45 people using the service.

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

Not all known risks had been assessed or mitigating strategies implemented to keep people safe from harm. People were at increased risks of skin pressure damage and risks from their health conditions. Staff had not always received appropriate training to understand people’s health conditions.

Medicine management required improvement to ensure people received their medicines as prescribed.

Care plans and risk assessments were not always kept up to date and factual. We found conflicting information had been recorded. Staff did not always have the information to support people safely.

Unexplained injuries had not always been investigated to identify a cause and reduce the risk of reoccurrence.

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 did not support this practice.

Oversight of the service required improvement. Systems and processes were not always effective in identifying improvements needed and mitigation of risks.

People and relatives had not been asked to feedback on the service. However, staff had completed annual feedback surveys, had regular supervisions, and were offered regular meetings.

People were supported by staff who had been safely recruited and who had completed an induction before working at OSJCT Longlands. Staff felt supported within their roles.

People told us they felt safe at OSJCT Longlands and were supported by staff who were kind. Relatives were positive about the support staff offered people. People and relatives told us they felt safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 December 2018)

Why we inspected

We received concerns in relation to staff understating people’s needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement based on the findings of this inspection.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for OSJCT Longlands on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicine records and management oversight at this inspection.

We have made a recommendation regarding understanding the Mental Capacity Act and Deprivation of Liberty Safeguards.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People received compassionate support from caring and committed staff. People told us staff were kind and respectful and treated people with dignity and respect. Staff knew what was

important to people and ensured peoples confidentiality and privacy were respected and their independence was promoted.

People received support that met their needs and was in line with care plans and good practice. People were supported to maintain good diet and told us they enjoyed the food at Longlands. People's rights to make own decisions were respected.

People were supported to access health services when required. People complimented the

continuity of care provided by skilled and competent staff. Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision.

The provider followed safe recruitment processes. Staff understood their responsibilities in relation to protecting people from the risk of harm. Where risks to people had been identified, assessments were in place and action had been taken to manage these risks. People received their medicine as prescribed.

The service was well run. Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery. There weresystems to assess the quality of the service provided. Learning from audits took place which promoted people's safety and quality of life.

Rating at last inspection: Good (report published 2 June 2016).

About the service:

Longlands is a care home which is run by The Order of St Johns Care Trust. 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. The service can provide accommodation and care to 48 people. At the time of the inspection 48 people lived there.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. Ongoing monitoring included information that quality had improved. We checked this in looking at the quality and safety of the service.

Follow up:

We will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

More information is in Detailed Findings below.

Longlands is registered to provide accommodation for up to 48 older people who require personal care. At the time of the inspection there were 46 people living at the service.

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 were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities.

Where risks to people had been identified, risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicines as prescribed.

Staff understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

People received person centred care. People were cared for by a service that understood the importance of getting to know the people they supported. People were supported to avoid social isolation through a wide range of activities.

There were sufficient staff to meet people’s needs. The service had robust recruitment procedures in place which ensured staff were suitable for their role. People told us they benefitted from caring relationships with the staff who knew how to support them.

Staff were supported by a registered manager that led by example. Staff had access to effective supervision and training to enable them to provide good quality of care.

Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery. The service had systems to assess the quality of the service provided in the home. Learning was identified and action taken to make improvements which improved people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

The service sought people’s views and opinions and acted upon them. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. We saw complaints were dealt with in a compassionate and timely fashion.

We considered our inspection findings to answer the questions we always ask:

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found.

Is the service safe?

We saw that care plans identified risks to people's health and welfare. For example, we saw that one person, who had been identified as at risk of developing pressure ulcers, had specialised equipment in place to prevent skin damage.

Medicines were safely administered. Care workers who administered medicine had been trained in administering medicines and had their competencies assessed. We saw a signed list of staff who administered medicines, which showed they had been competency assessed. We saw in one person care plan that they self-medicated their inhalers; a risk assessment had been completed for this and signed by GP and resident.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at five people's care records and saw that plans and assessments were person centred and written with the involvement of the person. This information had been used to form an individualised care plan. For example we saw that one person's care record showed the person loved books and always liked to carry them around. We observed this person during our visit and saw they enjoyed reading.

People told us they had regular access to health care professionals. During our inspection we observed care staff speaking with a person's G.P and arranging for a visit. The home recorded the outcomes of all health care visits in the persons care record. This ensured people had access to health professionals and that there was a team approach to care delivery.

Is the service caring?

People's privacy and dignity were respected. We saw that care staff treated people with dignity and respect. For example during a residents meeting we observed care staff supporting people to attend and participate in the meeting. One care staff member spoke clearly to a person, kneeling down so that there was eye contact. The care worker placed a hand on the person's arm in a sensitive and caring manner.

The home had an activities coordinator and we observed them organising and facilitating activities for people to join in with. For example, a music session was organised where people were listening to music then playing instruments. We saw people who were unable to join in were smiling and seemed to be enjoying the music. People told us activities frequently took place and we saw records of them in people's activity logs.

Is the service responsive?

The provider took account of complaints, comments and feedback to improve the service. We saw examples of where reflective meetings had been held with staff following complaints received to discuss lessons learned. The manager shared with us the learning from a complaint which had identified action to improve communication with district nurses. We saw evidence that the home had taken steps to implement this improvement.

Care workers had an awareness of people's dietary needs. Care records showed us that people were weighed monthly. Staff told us that if there was weight loss this would be notified to G.P's and person would be weighed weekly. Care records identified people's special dietary requirements. For example one person had diabetes. The chef had a list of people's dietary requirements.

Is the service well led?

There were systems in place to regularly assess, and monitor the quality of the services provided. The organisation had a system in place to monitor performance and compliance of the home against organisational standards. The organisation compiled a six monthly quality risk profile of the home which incorporated the results from the homes quality monitoring systems in place. These systems included a monthly operational review carried out by the area manager, looking at areas such as falls, weight loss, medication errors, complaints, safeguarding's. Regular audits such as health and safety, infection control and medication were carried out internally and we saw examples of these and actions identified and completed as a result of the audits.

Residents meetings were held once a month. During our inspection we observed the manager holding a residents meeting. The meeting involved the chef and the activity coordinator. People were encouraged to make suggestions about the menus and their individual requests were responded to in a positive manner.

We spoke with people who told us their concerns would be taken seriously by care and senior staff. One person told us "I feel safe because the staff know what happens in the home and would report things to be person in charge". Another person told us "I feel safe because my family visit and I would tell them if I was worried about anything". Another person told us "the carers ask me if I am alright, they would know what to do if I wasn't".

We looked at medication administration records. Where creams or required medication (PRN) had been prescribed, this was reflected on the appropriate care plan.

People that we spoke with said there were usually sufficient staff on duty. One person told us "sometimes there are fewer carers, but not often". Another person told us "I like all the staff who work here, they tell me to just ask if you want anything".

We were able to see complaints records. All complaints whether written or verbal were recorded with details of the complainant, the complaint details, letters, action taken and outcomes.

People who managed their own medication, completed a risk assessment that had been signed and dated by their GP.

We spoke with people using the service and staff about the staffing levels. People told us that the staff were kind and caring.

Staff spoken with said that they had enjoyed working in the home, and many had been employed for several years. Comments made by members of staff included " feel that I'm giving something back","I feel well supported","I'm very fond of the people living in the home","we work well as a team" Several members of staff said that had they not enjoyed working at the home, then they wouldn't have stayed for so long..

There was a large staff team employed. There were vacancies for care assistants, head of care and a domestic assistant post. These posts were being covered by bank staff, staff working additional hours and assistance from staff in other OSJCT homes. Vacant posts were being advertised.

We were told by people that they had not needed to make a complaint, but if they had, then they would have spoken to a member of staff.