Archived: Longfield Manor

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with seven people using the service, one relative and seven staff. We also reviewed records relating to the management of the service and four people's care and health records. We observed interactions between staff and people who lived at the service for one and a half hours during the morning and lunchtime period.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People had care plans that were detailed and provided up-to-date information about their care needs. The selection of care plans that we looked at demonstrated that people or their representatives had been consulted and that their personal needs and preferences were reflected.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we saw that applications had been submitted and were in the process of being completed for four people. The manager demonstrated knowledge and understanding of safe procedures that should be followed when considering depriving someone of their liberty. Since our last inspection one person had moved from Rosewood to another part of the service in order that their movements were not restricted by the keypad exit door. This meant that their rights were protected.

Is the service effective?

We found that people's health and care needs had been assessed and that a plan of care was in place. This included care plans for nutrition, skin integrity and moving and handling. This meant staff had up to date information to follow to ensure they met people's needs.

The majority of staff had a good understanding of people's care and support needs. They were able to tell us what people could do for themselves and areas where support was required. For example, one member of staff told us about a person who recently moved to the service, 'They can communicate their needs but they need a bit of help with personal care. It's more about prompting, encouraging and reminding really'.

Is the service caring?

In the main, people were supported by kind and considerate staff. We saw that staff showed patience, were attentive and gave encouragement when supporting people. People that we spoke with confirmed this. One person told us, 'They (staff) are lovely'. Another said, 'I'm happy at times. Some staff sometimes don't take their time'. In a recent feedback survey one relative had commented, 'All our family are impressed and grateful for the kind and caring staff at Longfield'.

Is the service responsive?

People's assessments and care plans had been reviewed on a regular basis. This meant that assessments and care plans reflected the current needs of people.

People and their representatives told us that they were able to raise suggestions or concerns. Relatives told us that they were kept informed and updated if there were any issues or concerns regarding the health of their family member. We found that the service listened and responded to questions and feedback received from people, their representatives and from staff.

Is the service well-led?

A new manager was in post at the service and was in the process of registering with us. They had taken action to monitor and assess the quality of the service. Where necessary, action plans were in place that detailed steps to address any identified shortfalls. Actions that we sampled were complete or in hand. This meant that systems were in place that ensured that the quality of service was regularly monitored and assessed. People and their relatives spoke positively about the changes that had taken place. One relative told us, 'With X (the manager) here it has made a difference'.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. In most instances, we saw evidence that appropriate action had been taken to minimise the risk of repeat events and potential harm to people using the service. These actions included a review of care and input from other healthcare professionals. This reduced the risks to people and helped the service to continually improve.

The summary is based on our observations during the inspection, discussions with five people who lived in Rosewood, six people who lived in the main part of the service, four relatives, the registered manager, two nurses, six care assistants, the chef, two kitchen assistants, two domestic staff and two activities staff. We also reviewed records relating to the management of the home and four people's care and health records. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff in Rosewood and in the main part of the home. We observed interactions between staff and people who lived at the home during the morning and lunchtime period for three hours.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Since our last visit, the service had reviewed the staffing numbers. There was an additional member of care staff working in Rosewood and additional activity hours had been allocated throughout the service. Staff also told us that there had been improvements in the paperwork they used which saved them time. Our observations during the visit were positive. We saw that people received timely and appropriate support. This meant that there were sufficient numbers of staff on duty to meet people's needs.

Staff had been trained to understand how to care and support people with dementia. Staff that we spoke with demonstrated knowledge and understanding in relation to supporting people with dementia. As one member of staff explained, 'It's important people are treated as individuals, given choices and treated as human beings. These are basic rights that everyone should have regardless of having dementia or not'.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Since our last visit one application had been made. The manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

People that we spoke with told us that they were happy with the care and support they received. For example, one person said, 'They help me get up in the morning. They know what I like'. A relative said, 'We have no concerns with the care provided. X (referring to their family member) can be difficult at times because of their dementia and they know how to deal with X'. It was clear from our observations and from speaking with staff who worked in Rosewood that they had a good understanding of people's care and support needs and that they knew them well.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when they supported people. For example, we saw staff assisting people to move around the home. When doing this they encouraged people to do as much for themselves as possible, whilst still offering support and guidance.

We noted that the lunch period was well paced and allowed people the time they needed to eat their meal. Some people were provided with aprons to ensure their clothes were protected if they spilled any food. We observed good interactions between people and staff. Staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

Since our last inspection staffing levels had increased in Rosewood. As a result people received care and support when they needed it. The choice of activities had also increased. A relative told us, 'Staffing has improved. They even take them out once a week now in the minibus'. Throughout the home, we observed people participating in a number of activities that stimulated and entertained them. When these took place the atmosphere was lively and people of all abilities appeared to enjoy themselves. One member of staff told us, 'There's more going on'. A person explained, 'We do get entertainment, singers and various people'.

At our last visit we found that people were not always offered a choice of meal, other than when they refused what was served to them. At this visit we saw records which demonstrated that people had been offered a choice of meal. There was also an alternative menu available. We observed that one person opted for a sandwich rather than the hot option that they had originally requested. This demonstrated that people's choices were taken into consideration and respected.

We found that the service had responded positively to the concerns raised at our previous visits. We also noted that residents' meetings had been reintroduced. This provided people with an opportunity to share their views and to make suggestions regarding the service.

Is the service well led?

Since our last visit a new manager was in post at the service and had applied to register with us. People and staff spoke positively of the new leadership and direction in the home. Staff comments included, 'Things are looking up', 'It's had its lows but it is much better now' and, 'Since the new manager has been on board it has picked up. It's going up'. One relative told us, 'The standards all round have improved'.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that there were not always enough suitably qualified or experienced staff to ensure that people's needs were met in a timely and safe way. There was no evidence to demonstrate that people's needs had been considered and used to determine the staffing numbers and skills mix required. This is being followed up with the provider.

When we last visited this service we identified issues relating to the management of medicines prescribed on an 'as required' basis and to prescribed creams. At this inspection we found that provider now had appropriate systems in place. Medicine was stored, administered, recorded and disposed of in a safe way.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. On the day of our inspection we were told no applications had been made to deprive someone of their liberty as it had not been necessary. Staff that we spoke with told us that they understood when an application should be made to deprive someone of their liberty. We found, however, that appropriate procedures had not been followed. One person had been transferred to Rosewood, part of the home that caters for people living with a dementia, after leaving the home without support on two occasions. A key code is required to exit this part of the home. This person had not been subject to an assessment to determine if they had mental capacity to make choices about the treatment provided. This meant that their right to make choices was not protected.

Is the service effective?

We found that most people's health and care needs had been assessed and that a plan of care was in place. This included care plans on communication, nutrition, social care and maintaining healthy skin. When we looked at a selection of care plans we found that these had not always been reviewed and updated to ensure that they still met people's needs. Half of the care plans that we looked at had not been reviewed at the monthly frequency determined by the provider. We also found positive examples of regular monthly review and updates when people's needs had changed. This meant that whilst we found evidence of good care planning, the service did not have a consistently effective system in place to ensure people's needs were met.

We found that some people's care was not delivered in line with their care plan. For example one person was said to require the assistance of staff to move safely around the home. We observed that they were often left unattended or that domestic staff were asked to assist in keeping the person safe. Where people had been assessed as at risk of malnutrition they were due to be weighed on a weekly basis. We found that this guidance had not been followed in four of the six cases that we looked at. This meant that people were at risk of not having their needs met because the service had not followed their plan of care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to planning and delivering care to meet individual needs and to ensure people's welfare and safety.

Is the service caring?

In the main part of the home we observed that people were treated with respect by staff. One person told us, 'They're all very kind'. In a recent feedback survey received by the provider a relative had written, 'I have always found that X has been treated with the utmost kindness'. We were concerned, however, that the dignity of people living in Rosewood was not ensured. For example, we heard staff asking about people's personal details in communal areas where they could be overheard by others. We observed one person eating with their fingers because a spoon had not been provided and noted incidents where people had been incontinent of urine that went unnoticed by the staff on duty.

We found that people's social and emotional needs were not always met. Beyond delivering the personal care that people required, staff did not appear to have time to spend with them. One member of staff said, 'You just haven't got time for it, it's sad'. Referring to a lounge area, one relative told us, 'They're often just 'parked' in there'. People told us that the staff were rushed. One said, 'Staff used to stop and chat ' one or two still do'. On the day we visited, there were no activities taking place in the home.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to respecting and involving people.

Is the service responsive?

On a number of occasions during our visit we observed that people in Rosewood were ignored because the staff were either busy elsewhere or did not respond. Throughout the home we observed that people were often left unattended, watching the television, observing their surroundings or sleeping.

We found that people were unable to choose what time they would like to get up because staff were not available to support them. We observed that people were not offered a choice of meal at lunchtime, unless they refused the meal served to them. This meant that the service did not always support people in making decisions relating to their care.

Most people and relatives that we spoke with told us that the home had responded to their comments and concerns. One relative said, 'If ever I ask anything, it's always done'. We saw that complaints received by the service had been responded to appropriately.

Is the service well-led?

The service has been without a registered manager since April 2013. Since this time the home has had three interim managers and a forth has started since our inspection. One person told us, 'It's a bit awkward, there have been a lot of changes'. We will follow up with the provider to ensure that a manager is registered for the service.

The service did not have an effective quality assurance system. Actions identified by the provider as necessary to achieve compliance with the regulations following our last visit had not been sustained. We did not see evidence that the provider learnt from accidents and incidents in order to reduce the risk of harm to people using the service.

We have asked the provider to tell us what they are going to do to regularly assess and monitor the quality of the services provided.

We spoke with 13 members of staff. They all told us that things had improved in the home. One said, 'The bad atmosphere has gone, it has got better'. Another told us, 'I can see it improving slowly'. Some members of staff said that they would welcome more communication from the management. One said, 'The staff are still feeling low, we need to be listened to and not blamed'.

We spoke with three relatives. They also felt that there was an improvement. One said, 'Things are getting better slowly but surely, I think the atmosphere is much better now'. Another told us, 'A number of the areas that we were unhappy with have improved a lot, some still need to be worked on'.

We found that the home had taken significant steps to address the issues identified. They had worked closely with the local safeguarding team and sought advice and support from both internal and external sources. People, their relatives and staff all felt that there had been an improvement. We found that the provider was now meeting standards in most of the areas where shortcomings had been identified.

We found, however, that action was still needed to ensure that all people who used the service were treated with dignity and respect. We also found that there were inconsistent practices in the management of medicines. This placed people at risk of harm.

We spoke with nine members of staff. They were all concerned about the home and the standard of care that people were receiving. They told us that a lot of their colleagues had left and that they were frequently working with temporary staff. One told us, 'The standard is really going down'. Another said, 'It's heart breaking. It's (their concerns) falling on deaf ears, they don't care' and, 'The staff morale is so low'.

We spoke with six relatives. They were worried about the staffing situation in the home. One said, 'I don't know many of the staff anymore'. Another told us, 'The atmosphere has gone down' and, 'If it was a five star, I'd put it down to a two star now'.

Whilst we observed some positive care and support, we found that that people did not always receive the support they needed in a timely or safe manner. The change of staff employed by the home meant that people were routinely supported by staff who were unfamiliar with their needs. Care records were unclear and inaccessible which meant that staff frequently relied on verbal instructions. As a result we found that care was not always delivered in line with people's assessed needs. Because staff were stretched we found that people were regularly denied a choice, for example in the time they wanted to get up, go to bed or what they wanted to eat. People, relatives and staff told us that they felt reluctant to complain for fear of the consequences.

We also spoke with two visiting relatives. They both told us that they were happy with the quality of care given to their family member. One told us that their relative had been admitted to the home in a poor physical condition but had made a substantial improvement since. They credited the home and local GPs for this recovery.