Long Lea Residential 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 changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager understood their responsibility under duty of candour to be open and transparent with people and their relatives. Where accidents and incidents had occurred, people and relatives were informed.

Staff told us information was shared following adverse incidents to communicate any learning and improve practice. One staff member told us, “You must report any problems (accidents/incidents) to the senior. You say what happened and they fill in the forms. I was told about this at induction.” Another staff member explained, “We have flash meetings every day where we discuss and share. If a resident has had a fall, we would talk about to see if we can do things better.”

The provider had systems for reviewing accidents and incidents. Reviews were initially completed by managers within the service to ensure immediate actions had been taken to keep people safe. This included reviewing people’s risk assessments and care plans and referring them to other healthcare professionals for advice and support. Accidents and incidents were reviewed electronically by the provider to ensure required actions had been completed and to identify any patterns and trends.

The provider 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.

Managers carried out pre-admission assessments to ensure a smooth transition from home or hospital to Long Lea Residential Home. One person told us, “They had a chat with me and my daughter initially where they covered everything.” A senior staff member explained, “Managers do assessments, so we have information before people move in. We can then prepare, say arrange for the district nurse and tell the carers about the new resident and what they need.”

There were processes to ensure information was shared with other healthcare professionals when people needed prompt support owing to health emergencies. This included information about any risks to people’s health, their medication and their wishes for future care. Processes ensured people did not miss medical appointments and people had appropriate support to promote continuity of care. The deputy manager explained, “The senior will liaise with the family to see if they are going to support or if an escort is needed for the appointment and then we would arrange the transport. They would let us know if we needed to bring someone in to act as an escort so we can plan on the rota.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at Long Lea and were confident staff provided them with safe care. Comments included: “I am safe, yes. If there was any reason not to be, I’d see the manager”, “Very caring staff in here” and “The staff are excellent. I feel 100% safe.”

Staff received training in safeguarding people from harm, discrimination and abuse. Staff told us they would not hesitate to report any poor practice or suspected abuse to senior staff and managers. One staff member told us, “I did the training. Abuse can be sexual, emotional, financial, physical. Even if you think but are not sure something is wrong, you must tell the manager.” Staff told us they would escalate their concerns to other agencies with responsibilities for promoting people’s safety if they felt appropriate action had not been taken to safeguard people. One staff member commented, “Our manager would investigate everything but make no mistake, if they didn’t, I would be on the phone straightaway to safeguarding and CQC myself. Residents are the priority.”

The registered manager worked in accordance with the provider’s safeguarding policy to ensure concerns were investigated and referred to the local authority safeguarding team. The registered manager maintained a log of all safeguarding referrals, and these were escalated to the provider for further review and analysis.

When someone was identified as potentially being deprived of their liberty, applications were made to the authorising body as required. Staff were aware of those people who had authorised DoLS in place. One staff member explained, “The DoLS are to keep people safe. Many of our residents would get run over or get lost if they went out on their own so they have a DoLs. That means they don’t go out on their own. Everything is in the care plan.” Nobody had a condition on their DOLs at the time of our assessment.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Potential risks to providing people's care and support had been identified. People's care plans included the actions staff should take to minimise the identified risks. For example, assessments were completed in areas such as diabetes, catheter care, skin damage, the use of equipment and assisted moving. Information was accurately crossreferenced between risk assessments and care plans. One staff member explained, “What we need to do is in the risk assessments. Like I know [Name] has a chair mat to tell us when she gets up so we can go to her straightaway to stop her falling.”

Where people had specified pieces of equipment to support risk management recorded in their care plans, this was in place. For example, 1 person needed a crash mat and a sensor mat by the side of their bed to reduce the risk of them sustaining an injury if they had a fall from bed.We saw the person’s bed had been lowered and the equipment was in place. Some people required a pressure relieving mattress to reduce their risk of skin damage. We checked 3 people’s mattresses and found they were on the right setting for their individual weights.

Staff understood their role in recognising and mitigating risks to people’s safety. When 1 person, who walked with the aid of a walking frame stood up, a staff member approached them and discreetly walked by their side. The staff member was heard giving reassurance and encouragement. When asked about this the staff member said, “[Name] can be unsteady, so we keep an eye on them. It’s great that she walks about, and we don’t discourage that, but walking by her keeps her safe.” Another person expressed a wish to sit in the garden because it was a bright sunny day. A staff member collected a sun hat from the person’s bedroom, assisted them into a shady part of the garden and then periodically went out to check on the person.

Risk management plans were regularly reviewed to ensure any changes in people’s risks were identified and planned for.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff understood their responsibility to keep people safe and report any concerns relating to equipment or the environment. We observed a new staff member working with an experienced staff member to support a person to move from their lounge chair to the dining room table. The experienced staff member explained the importance of checking the hoist and sling prior to use and the actions to take if there were any safety concerns about the equipment. Another staff member told us, “On my induction I learnt health and safety is important for the residents and us. Good health and safety keeps everyone safe. You must keep looking and if you see anything, you report it. I would tell the senior or team leader.”

The registered manager carried out regular health and safety checks of the environment. Any issues identified during the checks were added to a maintenance log and addressed promptly. The provider had processes to ensure the premises and equipment were regularly checked and maintained in good order.

Staff had completed fire safety training and understood what action to take in the event of a fire or other emergency. One staff member told us, “The deputy comes in during the night to do fire drills. I think that’s really good because you don’t know when she’s coming.” Information staff and the emergency services needed to keep people safe in the event of an emergency was up to date and easily accessible.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People felt there were enough staff because they did not have to wait long if they needed assistance or support. One person told us, “I do have a call bell, they come quite quickly unless they are busy. I have rung it at night, and they do come fairly soon.” Other comments included: “I think they are pretty good, if you need help you get it straightaway” and “The staff are always there for you. I ring my bell and at worst it is 10 minutes, otherwise it is straightaway.”

Staff told us identified staffing levels were maintained which enabled them to meet people’s needs safely and effectively. One staff member said, “Since I started, there has always been the right number of staff on duty.” Another staff member told us, “Everyone pulls together; we are a team. If someone is away, on holiday or poorly, then one of us covers their shift.” Throughout the inspection there was a staff presence in the communal areas and staff responded when people activated their call bells. However, on 3 occasions call bells were heard to ring for a longer period of time. The registered manager spoke to staff and reminded them of the importance of consistently responding promptly. The registered manager told us they regularly reviewed people’s dependency needs to ensure they received the level of support they required.

New staff received a 4-day face to face induction when they joined the service and then worked alongside more experienced staff to learn about people and their individual needs. A member of the management team explained, “We try to do it for a period of 2 weeks and have regular meetings with them to discuss how things are going. We also talk to the staff they have been shadowing and if there is anything they highlight or we observe, we will put them on further shadow shifts.” One staff member explained the benefits of shadowing and commented, “It gives you chance to learn what they (people) need and want. Having time to get to know everyone is good.” The provider required staff to regularly refresh their training to ensure their knowledge remained up to date and reflected best practice.

The provider operated safe recruitment processes. Safe recruitment checks Included undertaking checks such as references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had completed infection prevention and control training and followed safe infection prevention and control practices. One staff member told us, “If there was an outbreak we use yellow mops, yellow buckets, yellow everything. This alerts everyone to the outbreak. We did all this as part of our training. We commonly wear gloves and aprons but if there is an outbreak, we would wear masks as well.”

The home was clean and overall, well maintained. Staff had access to and were observed wearing and correctly disposing of personal protective clothing. Clinical waste and soiled laundry were managed and disposed of in accordance with best practice. One staff member told us, “The reason we have red laundry bags is to keep soiled or infected laundry separate.”

Audits completed by the management team identified areas for improvement and actions were taken to address these. People and relatives did not raise any concerns about infection control standards in the home.

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

People raised no concerns about the management of their medicines or the availability of pain relief when they needed it. Comments included: “I take medicines twice a day, it is all fine”, “I have it at the same time each day” and “If I was in pain, they would give me something.” People had regular reviews with other healthcare professionals to ensure medicines remained appropriate and effective.

Overall, medicines were managed, stored and administered safely, in accordance with best practice guidance. For example, staff had guidance to ensure consistency in the management of ‘as and when required’ medicines and that time critical medicines were given at the correct time. However, we found improvements were needed in the management of some medicines administered via a patch applied to the skin. Records did not always evidence these had been managed as per the manufacturer's instructions. The registered manager took immediate action to ensure the application site of all patch medicines was recorded on a body map. This will further help to promote people’s skin health.

People received their medicines from staff who were assessed as competent and had completed training in the safe handling and administration of medicines. The registered manager carried out regular checks of medicines to monitor staff practice and ensure people received their medicines as prescribed.