Longmead House

Longmead House is a care home providing personal care and support for a maximum of 23 people. Accommodation is set over three floors all of which have access via stairs or a lift. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 15 people using the service.

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

Risk assessments and support plans were not always in place to help staff to deliver safe care to people. Some risks had not been identified, managed and mitigated. We witnessed an unsafe moving and handling practice which put a person at risk of avoidable harm. People did not always receive their medicines safely and as prescribed.

Incidents and accidents were not always recorded appropriately, analysed or reviewed. There was no evidence lessons were learned from incidents and accidents.

People were not always protected from the risk of infection and cross contamination. On the day of our inspection, there was a malodour which persisted throughout the day. Furthermore, most areas of the home were dusty and unclean.

Although there was a fire assessment in place and records of fire safety checks, a person’s fire door was being propped open by an object. This put the person at risk of harm, should there be a fire.

Recruitment checks were not always carried out. One staff member’s file did not contain the necessary documents to help ensure they were fit to deliver care to people. There were no regular staff meetings or meetings for people who used the service.

People were not always treated in a kind and dignified manner. Some practices were task-centred and did not recognise people’s individual needs.

There were few activities taking place on the day of our inspection, and the activities on offer did not meet people’s needs. People told us they were bored. The environment and the activities had not been developed to meet the needs of people living with dementia.

Care plans were developed from the initial assessments and contained information for staff to know how to meet people’s needs. However, these had not been reviewed for several months. This meant we could not be sure people’s current needs were met.

The provider’s quality monitoring systems were infrequent and had failed to identify the shortfalls we found during our inspection. The provider had not carried out regular audits and checks of the service for several months. The service failed to demonstrate they were providing care and support that was safe, caring or responsive. This put people at risk of harm.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Rating at last inspection

The last rating for this service was good (published 6 June 2018). At this inspection the rating had changed to inadequate.

Why we inspected

The inspection was prompted in part due to a safeguarding concern. A decision was made for us to inspect and examine this risk. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements. 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 inadequate. This is based on the findings at 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.

We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, fit and proper person employed, person-centred care and good governance.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection took place on 12 April 2018 and it was unannounced.

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.

There was a registered manager at the service at the time of the inspection. 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.

At our last inspection in April 2016, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements to the care records they held on people, some of which were out of date or giving contradictory information about people’s needs. Following the inspection, the registered manager told us they would introduce a new care plan format and review people’s care records. We found that this had been implemented and saw some good examples of care records on this visit. The registered manager has recruited a deputy manager to support them with the record keeping and auditing the quality of care.

However, we found care planning and risk assessments needed to be more consistent and fully completed for all people. Other improvements that were needed at the last inspection had also not been fully implemented. The recording of mental capacity assessments were not always completed correctly in relation to the Mental Capacity Act 2005. People who had 'as required' (PRN) medicines still did not have a protocol in place. During and following our inspection the registered manager took steps to demonstrate to us they would put these things right. We will monitor this and check the improvements have been embedded into practice and sustained at our next inspection.

There were very good relationships between staff and people living at the home. Care was provided in an inclusive, person- centred way by staff, who were appropriately trained and supervised by a manager. There were sufficient numbers of trained staff to meet people’s needs safely. The provider had carried out appropriate checks on staff to ensure that they were suitable for their roles.

Staff were able to tell us of the risks to people and what they did to keep people safe. Staff understood their responsibilities under safeguarding and how to prevent and report abuse. People’s medicines were stored safely at correct temperatures in locked cabinets, and the management of people’s medicines was safe.

People were protected from infection and staff were practicing good hygiene. There were systems and checks in place to ensure cleanliness and to reduce the risk of infection.

The manager was working with staff to make changes in practice, using the learning from recent incidents.

People were receiving good and effective care. Each person had an assessment and care plan in place, and they were involved in deciding how their needs should be met. People were looked after by staff who had been well trained, and with the skills they needed to carry out their role.

People were supported to remain as healthy as possible. Staff enabled people to get specialist healthcare when it was required. There was evidence of good relationships with local health care professionals. The needs of people living with dementia were taken into account.

The building had been adapted to meet the needs of people living there whilst retaining a homely environment. Visitors and relatives were made welcome and people were supported to maintain relationships with people close to them.

People told us they were supported to live as they wished and be independent. Staff respected people’s wishes and choices and acted to improve their quality of life. People’s care plans were personal to them, and staff responded to their individual needs.

People said they felt able to complain or raise their concerns one of the managers.

There was a culture of open communication and the registered manager encouraged feedback, learning and support. The leadership style was person-centred and the care and welfare of people was the priority. Staff were involved in the running of the home and residents and relatives felt their views were heard and responded to.

We received positive feedback from staff, relatives and some healthcare professionals about the way the registered manager led the service. However, because we found continued inconsistency of governance and the recording of important information, we were unable to give a Good rating in all domains. The registered manager has taken action, but these changes need to be embedded and sustained within the practice of the service.

This was an unannounced inspection that took place on 26 April 2016.

The home 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

Care records for people were not always accurate and some information held was contradictory.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. People and relatives were happy with the care provided and they were made to feel welcome when they visited. Staff supported people to take part in various activities although we have recommended the provider consider introducing more purposeful activities.

Staff followed correct and appropriate procedures in administering medicines and medicines were stored safely and appropriately.

Care was provided to people by staff who were trained and received relevant support from their manager. This included regular supervisions.

Care plans were individualised and contained information to guide staff on how someone wished to be cared for. Information included detail around people’s mobility, food and personal care needs. Where people had risks identified guidance was in place for staff to help reduce these risks.

Quality assurance checks carried out by staff to help ensure the environment was a safe place for people to live and they received a good quality of care. Staff were involved in the running of the home as regular staff meetings were held. People were asked for their views about all aspects of their care and could make their own decisions. We received some good feedback at the home.

There were a sufficient number of staff to care for people. Safe recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home. Staff were able to evidence to us they knew the procedures to follow should they have any concerns about abuse or someone being harmed.

Staff had not always completed assessments in relation to the Mental Capacity Act 2005, however the registered manager took immediate action to address this. Staff were heard to obtain people’s consent before they supported them. Where people had restrictions in place to keep them safe, the registered manager had submitted the appropriate DoLS applications.

People had care responsive to their needs. People were provided with a choice of meals each day and those who had dietary requirements received appropriate food.

Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, dietician or district nurse.

Complaint procedures were available to people and there was a contingency plan in place should the home have to be evacuated.

There was an open positive culture within the home and it was evident the registered manager was respected by staff.

During the inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made some recommendations to the provider. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection, the service was providing personal care to 13 people. As part of our visit to the service we spoke with four people who used the service, the manager (who was also the provider), four members of staff and three relatives. We also spoke with a representative from Public Health England and the Surrey infection control lead who had been working with the service during a recent bacterial infection (MRSA) incident.

We reviewed records that related to the management of the service which included care plans, policies and daily records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that people lived in a safe environment. The service was clean and hygienic and people were able to move around the home and garden freely without any risk of harm.

We found that the provider had ensured that staff were provided with information that related to safeguarding vulnerable adults. Staff were able to tell us what they would do if they had any concerns. One relative we spoke with told us, 'To have peace of mind is the bottom line. We never have to worry about here.'

We were told that the service had had a recent incident of MRSA. We saw that notices had been displayed around the home to notify visitors and that the home had been closed to new admissions for several months. We heard from staff in relation to the additional guidance they had received from the provider to ensure they carried out the correct infection control procedures. We spoke with both Public Health England and Surrey's infection control lead. Both told us that they were satisfied with the response of provider and staff to their advice and guidance, which helped keep people safe.

Is the service effective?

Our observations told us that staff had a good understanding of people's needs. All of the people who used the service that we spoke with confirmed this. One relative we spoke with told us they had seen a difference in their family member since they moved in to Longmead House. They told us, 'Really picked up since they've been here.'

Is the service caring?

We saw that staff showed patience and gave encouragement when supporting people. We noted a comment from a recent satisfaction survey. One person who lived at Longmead House had written, 'I think they are all beautiful and very kind to me.'

People's preferences, interests, and diverse needs were met. We saw how one person liked to sit and do crosswords, whilst another preferred to spend time in their room.

Is the service responsive?

One relative told us that the service, 'Responded promptly' to any changing health needs of their family member. Surrey's infection control lead told us, 'The manager took on board all the guidance and carried out the expectations I had of them in relation to the recent incident.'

Is the service well-led?

There were regular meetings for the people who lived in the home.

We were shown that the service asked people who used the service, their relatives and visiting professionals to complete a satisfaction questionnaire. The results of these questionnaires were used to improve the service.

We inspected to follow up a compliance action from the last inspection under outcome 10 (regulation 15). At this inspection we found that the shortfall had been met and the compliance action was closed. We therefore found that People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People who used the service also told us they liked the home and their rooms, their rooms were warm enough and their taps worked properly.

People said they had no complaints but knew how to make one if they did. One person said they had no complaints and would not stay anywhere else.

We spoke to relatives of the people who use the service, who told us they felt their relative was well cared for, their room seemed warm enough and the food always looked good, they had no complaints and felt listened to when they raised any issues.

We observed staff treating people with dignity and respect. For example, we saw staff were always patient and gave time to people to talk to them for as long as they needed to be reassured or to just feel listened to, particularly when people were confused. We also saw staff taking people to the toilet discreetly, providing privacy by not standing right outside waiting and we saw them closing doors to bedrooms when supporting people with personal care.

Although we also found good practice with regards to the environment, we concluded that people who use the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises. This was because other than the sash windows, the window restrictors were either not fit for purpose, not robust enough or not secure, bedroom doors were being wedged open so they could not close to protect people in the event of a fire, low windows glass was not safe, and a rusting iron beam about 3 meters long was not secure and posed a serious risk of injury if it fell on someone.

We saw that people were given support to make a comment or complaint where they needed assistance, and people had their comments or complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.