Longacre Care Home Limited

Longacre Care Home Limited is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and nursing or personal care for up to 30 older people living with dementia, physical disabilities, and mental health needs. At the time of the inspection there were 20 people living at the home.

Longacre Care Home Limited is a detached property in a suburban area of Worthing. It has been adapted from a domestic house and has been extended. There were two passenger lifts so people can access the first floor and corridors had sloping floors rather than steps for those with mobility needs. All bedrooms were single apart from one which could be used as a double. Twenty bedrooms had an en suite toilet. People were observed using communal areas, which included two conservatories which people used for activities plus a lounge – dining room. There was a garden which people said they enjoyed using.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We made a recommendation following our last inspection on 29 January and 5 February 2016 for action to be taken to ensure people had access to a range of personalised activities and to address social isolation for those who remained in their rooms. The provider had taken action to address this and we found the provision of activities for people had improved.

People and their relatives said they were satisfied with the standard of care provided. For example, one relative said, “the care is good. The staff are fantastic. Nothing is too much trouble.” Another relative said, “It’s a lovely home. No faults at all.”

The provider ensured safe care was provided to people. Risks to people were assessed and measures taken to mitigate these. The premises and equipment were safely maintained. Action was being taken to address fire safety matters as required by the fire and rescue service. Sufficient numbers of care and nursing staff were deployed to meet people’s needs. Checks were made to ensure staff were suitable to work in a care setting. Medicines were safely managed. The home was clean and hygienic. Incidents or accidents were reviewed and action taken to reduce the likelihood of any reoccurrence.

The provider and management team ensured current guidance and legislation was followed regarding people’s care and treatment. Staff were well trained and supervised. The staff felt supported and valued.

People’s nutritional needs were assessed and people were supported to eat and drink. There was a choice of food. Health care needs were monitored and referrals made to other services to ensure there was a coordinated approach to people’s care. 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.

People were treated with kindness, respect and compassion. Care was individualised and reflected people’s preferences. People’s privacy and dignity were promoted.

People received personalised care which was responsive to their needs. Assessments, care plans and records showed attention to detail in monitoring and responding to people’s needs. The provider identified and met people’s communication needs. The provider had an effective complaints procedure and people and their relatives confirmed there was a good dialogue with the staff and management team so any issues were resolved. Whilst there were no people in receipt of end of life care at the time of the inspection the provider had policies and procedures for this. Staff were trained in end of life care.

The service was well led and provided person centred care. The provider’s values of compassion, care, commitment, competence and communication were prominently displayed and were reflected in the service provision. People and their relatives had opportunities to express their views about the service and were consulted about their care. There were comprehensive audits and checks on the quality and safety of the service with corresponding plans to make changes where this was identified. The registered manager and provider were committed to continuous improvement of the service.

Further information is in the detailed findings below.

Longacre Care Home limited is registered to provide accommodation for 30 older people who may require nursing or personal care. At the time of this inspection 23 people were living at the home, some people were living with dementia.

A registered manager was in post who was also a registered nurse. 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.

Longacre Care Home is two houses that had been converted into one large home with a front driveway. The home is situated in a residential area of Worthing. Communal areas included a large lounge leading to a dining area and access to spacious rear gardens. At the other end of the building there is a conservatory that leads into a hairdressing room. All bedrooms were of single occupancy apart from one which was shared.

We found the home to be clean and tidy and maintained to a high standard. Home furnishings such as pictures and flowers in vases decorated communal areas and hallways attractively. The ambience of the home was warm and inviting.

People and staff told us that they were happy with the activities that had been organised. However it was observed that some people may be at risk of social isolation due to remaining in their bedrooms or the way staff were deployed to facilitate activities. We have identified this as an area for further improvement. The registered manager was able to share how this was managed and was open to improving interactions with people where possible.

People and their relatives felt that Longacre Care Home was a safe environment. There was sufficient staff who had been trained in how to recognise signs of potential abuse and protected people from harm. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. People’s medicines were managed safely and administered by trained staff. The service followed safe staff recruitment practices and provided a thorough induction process to prepare new staff for their new role.

Staff demonstrated how they would implement the training they received in core subject areas by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager.

Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. They also understood the associated legislation under Deprivation of Liberty Safeguards and restrictions to people’s freedom.

Additional drinks and snacks were observed being offered in between meals and staff knew people’s preferences and choices of where and what they liked to eat.

Staff spoke kindly to people respected their privacy and dignity. Staff knew people well and had a caring approach. People’s spiritual and cultural needs were taken into account of and they were supported to follow their religious preferences. At the end of their lives, people were supported to have a comfortable and dignified death.

People received personalised care. Care plans reflected information relevant to each individual and provided clear guidance to staff on how to meet people’s needs. There was a complaints policy in place. All complaints were treated seriously and were managed in line with this policy.

People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and treatment. Relatives were also encouraged to give their feedback on how they viewed the service and where necessary support with the reviewing of the care plans alongside more senior staff.

A range of quality audit processes overseen by the registered manager were in place to measure the overall quality of the service provided

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?

People told us that they felt safe. Safeguarding and whistleblowing procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to maintain safe care. The provider had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications were in place at the time of inspection.

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the process and that they reflected their current needs.

Relatives confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person said, "It's a home from home here. I couldn't ask for more".

People living at the home and their families completed an annual satisfaction survey. These were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People engaged in a range of social, educational and vocational opportunities which were devised in conjunction with them and their families.

People knew how to make a complaint if they were unhappy and these were dealt with by the home in a timely and satisfactory manner.

Is the service well-led?

The home worked well with other agencies and services to ensure that people received their care in a joined up way. The home also operated a quality assurance system which identified and addressed shortcomings. As a result, the good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were looking after and were properly trained to carry out their duties.

We found that people's care was planned and delivered in line with their individual needs and preferences. People had individualised care plans in place which informed staff and assessed risk. People's care plans were reviewed and updated regularly.

The provider had implemented a cleaning procedure and schedule. All staff, including cleaning staff, had received infection control training. Staff understood their responsibilities regarding the daily cleaning of the home. Additional cleaning staff had been employed to ensure that the home was cleaned regularly.

There were enough qualified, skilled and experienced staff to meet people's needs. The service had employed additional staff to meet the needs of the people who lived at the home. People who lived at the home commented that the service had improved as a result of additional staff being appointed.

People were now protected from the risks of unsafe or inappropriate care and treatment because records were adequately maintained.

We found that people's consent had been obtained both verbally and in writing. People's care plans were discussed with them and their wishes were upheld.

We found that people's capacity to make decisions about their care and treatment was assessed appropriately. People who did not have capacity, relatives were consulted to ensure care was provided in people's best interest.

We found that people were treated with respect and dignity. People and their families were involved in care planning and care decisions. However, there were gaps in the way that consent was obtained and how people's capacity was assessed and documented.

Although people felt the home was clean and hygienic, there was no cleaning or maintenance programme in place to maintain the cleanliness and of the premises.

We found there were not enough staff to provide care and support to people.