Longbridge Deverill House and Nursing Home is made up of two buildings on the same site. The house is a residential care home for up to 20 people and is located at the front of the grounds. The nursing home is situated towards the back of the grounds and up to 60 people can live there for residential, dementia, and nursing care.
People’s experience of using this service and what we found
This inspection took place at 5.30am due to concerns about people having to get up early. We found most people were in bed in their nightclothes. Some people were in the communal lounges, but this was their choice. Whilst staff explained people were encouraged to get up when they wanted to, there were some comments about specific staff assisting people from 4am onwards. The manager said they were aware of this and had spoken to staff. However, checks to ensure this practice was not taking place, had not been undertaken.
Staff told us they generally started assisting people with their personal care at around 6am. They described this as, “starting their rounds” or “pad changes”. This terminology and practice were not person centred and did not promote a 24-hour approach to care. The manager said they would address this within staff meetings.
Audits to check the safety and quality of the service had been undertaken. However, whilst the audits had identified some shortfalls, action plans had not been documented. This increased the risk of shortfalls not being appropriately addressed.
Not all risks to people’s safety had been identified. This included one person who had their legs over their bed rails and another who had their table too high to eat safely. There was a hot water urn in a nurse’s station, and staff took drinking water from a hand wash basin, next to a toilet in an en-suite. The manager told us they would consider and address these areas without delay.
Food and drink within the kitchenettes were not stored safely. Dates of opening and expiry dates were not recorded, which did not ensure the items were safe to use. People had snacks, such as biscuits and crisps, available to them during the night but there was no access to the main kitchen. The manager told us they had identified the range of food available at night, was limited. They said a review of all food and snacks was being undertaken.
People were encouraged to give their views about the service. Records of ‘resident’ and relative meetings showed the points raised, but action plans were not in place. This did not show people were being listened to, and their views were being addressed.
Whilst staff said they had a good team, they felt there needed to be an increased management presence within the home. They said the manager’s leadership did not fully inform them of the ethos or direction of the service. Staff told us the manager was often office based and did not know people or staff well. The manager was aware of this and said they would be addressing the amount of contact they had with people and staff.
The manager was aware of their responsibility regarding the duty of candour. Since their appointment, they had spent time considering what worked well and what needed improvement. They were committed to improving the service and had recruited additional staff to minimise the use of agency staff.
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 07 February 2019).
Why we inspected
The inspection was prompted due to concerns received about some staff assisting people to get up as early as 4am. There were also concerns about the lack of food available to people during the night, and staff not being able to access continence supplies.
Following the receipt of the concerns, a decision was made for us to inspect and examine the risks. We undertook a targeted inspection to review the key question of well-led only.
CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.
After the inspection, the manager sent us an improvement plan. This showed actions that were being undertaken to monitor and develop the service.
You can see what action we have asked the provider to take at the end of this full report.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.