Archived: Longhill House - Care Home

The service had a registered manager in post as required by a condition of registration. 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.

We undertook this unannounced inspection on the 17 and 18 November 2016. At the time of the inspection there were 38 people living in Longhill House.

At the last inspection on 14 September 2015, we had concerns about infection prevention and control and how the quality of the service provided to people was monitored. The registered provider sent us an action plan which stated the measures they were to take to improve and when they would be compliant in these areas. We found there have been improvements in both these areas at this inspection. For example, we found the service was clean, tidy and smelled fresh. Some minor issues were attended to on the day of inspection. Staff had appropriate personal and protective equipment to use when required and there were sufficient supplies of cleaning products.

The registered manager was carrying out more audits and checks on the quality of the service and asking people their views in surveys and meetings. We saw some areas required review to continue the improvement achieved so far, especially in relation to records. We have made a recommendation about this in the well-led section.

During this inspection, we found people had not always received their medicines as prescribed. You can see what action we have asked the registered provider to take at the back of the full version of this report.

Staff knew how to keep people safe from the risk of harm and abuse; they had received relevant safeguarding training and knew how to report issues of concern. Staff completed risk assessments for people who used the service to help them minimise risk and keep people safe. The registered manager had looked at accidents and incidents so staffing levels could be adjusted at specific times of the day in order to reduce the number of incidents.

We found people’s health care needs were met. Staff had developed good relationships with health care professionals and they made referrals to them when required.

People’s nutritional needs were met. There were choices available for them on the menus and alternatives if they didn’t like what was on offer. Nutritional risk was assessed and people were weighed in accordance with risk and their diet adjusted when required.

People’s needs were assessed prior to admission and this was kept under review and updated when there was any significant change. People had care plans which provided staff with guidance in how to look after them. Some care plans were very detailed but others lacked some information which could be relevant to their care. However, in discussions it was clear that staff were very knowledgeable about people’s individual needs and how each person preferred to be cared for. The registered manager confirmed the minor issues with care plans were to be addressed straight away.

We found the staff approach was kind, patient and caring; there were positive comments about staff approach from people who used the service, relatives and visiting professionals. Staff respected people’s dignity and privacy and we saw them encourage people to be as independent as possible and to make their own decisions when they were able to. When people were assessed as lacking capacity, staff acted within the principles of the Mental Capacity Act 2005 and ensured important decisions were made within best interest meetings with relevant people attending.

We saw confidentiality was maintained and personal data protected and stored securely.

Staff had access to training which helped them to feel skilled and confident when supporting people who used the service. The training was monitored and refresher courses made available; there was an expectation that staff completed training in a timely way. There was an induction which covered training considered as essential and which gave new staff basic skills on which to build on. Staff received supervision, appraisal and support.

We found the registered manager was approachable and people who used the service and their relatives were listened to. There was a complaints procedure on display and people felt able to complain.

At the last inspection in September 2015, staff had been recruited safely and all employment checks had been carried out before they started work in the service. The recruitment process had not changed in the interim so we did not feel it necessary to check this again. Recruitment processes will be checked at the next inspection to ensure the robust processes continue to be maintained.

The provider sent us an action plan outlining how they intended to comply with actions set.

During this inspection we found the provider had complied with the actions we asked them to take.

The provider had implemented new monitoring tools to ensure people's care needs were met appropriately. The provider had also improved the way staff were supervised and senior staff had been given the responsibility to ensure people's personal care needs were met. We saw people who used the service were clean, tidy and were wearing appropriate clothing.

The provider had increased staffing levels to ensure people's needs were met more effectively. Staff told us they now found the work less stressful and had more time to sit and talk to people.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

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

Is the service safe?

There was insufficient staff on duty at specific times of the day and night. This placed people at risk of inadequate care and supervision. A health professional told us, 'I have seen incidents between people (who use the service) when staff have not been around.' Staff also told us there were specific times of the day when they required more staff such as in the early evening.

The service was clean and hygienic. Equipment used in the home was serviced and regularly maintained to ensure it was safe to use. The building was secure and staff had completed environmental and fire risk assessments to minimise the risk to people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having sufficient staff on duty at all times.

Is the service effective?

One person had not received oral care for a week even though this had been documented as required in their assessment and care plan. Another person had tipped hot drinks over themselves three times since January 2014 and staff had not completed a risk assessment and care plan for them to minimise the risk. This placed the person at risk of further incidents.

People were asked for their consent prior to care and support and were asked for their views about activities of living on a daily basis. Mental capacity assessments were carried out and best interest meetings held when people lacked capacity and important decisions were required.

People's mobility needs and other needs were taken into account in relation to signage and building layout, which enabled people to move freely and safely on the ground floor and into the garden.

Visitors confirmed they could visit their relatives in private and visiting times were flexible.

People's care was coordinated with other health and social care professionals in the community and when admissions to hospital were required.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing risks, monitoring personal care tasks and meeting their assessed needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed encouragement and patience when supporting people.

People's preferences, routines, likes and dislikes had been recorded and care and support was provided in accordance with people's wishes and choices. Staff demonstrated they knew people's needs and preferences.

Relatives spoken with were happy with the care provided to people and they commented on positive staff attitude. They said, 'I am very happy with the home; they always get the doctor out to her quickly', 'They keep me informed' and 'I like the staff and get on with all of them.'

Is the service responsive?

People had access to a range of health and social care professionals such as GPs, community nurses, dieticians, speech and language therapists, social workers, dentists, opticians and podiatrists. There was evidence the staff team sought appropriate advice, support and guidance during emergency situations.

People were able to complain and we saw these were investigated and addressed.

Comments from people who used the service included, 'On the whole everything is alright and the staff help me.' A relative said, 'The staff always ring me up and let me know if there are any problems.'

Visiting health professionals said, 'The staff are really helpful and inform us if there are any problems' and 'They ring the district nurses for the slightest thing but we would rather have it that way; they don't leave things to get worse.'

Is the service well-led?

The service worked well with other agencies to make sure people received their care in a joined up way.

The service had a quality assurance system, which included audits and seeking people's views. Checks of the environment were carried out. There was a complaints process and people were made aware of this.

Staff told us they were clear about their roles and responsibilities, had access to training and were well supported by management. Staff had an understanding of the ethos of the service and worked well as a team. Comments from staff included, 'Management is supportive; they help with any problems and will tell you where to go to get information', 'We get plenty of training; I've completed dementia training at level 2 and 3.'

At our last inspection of the service on 3 April 2013 we issued a compliance action as we were concerned some areas of the service were not as clean and hygienic as required. Following the last inspection the service had produced an action plan to address the concerns raised. During this follow up inspection we checked progress with the action plan and found that improvements had been made to the environment. All areas were clean and tidy.

Care files contained information from GPs, chiropodists, emergency care practitioners (ECP) and the falls team. Risk assessments had been completed for areas including falls, skin integrity, moving and handling and wheelchair use. The care files were evaluated on a monthly basis to ensure their accuracy and then updated as required.

We spoke to several members of staff about their understanding of abuse. They independently described the different types of abuse that can occur and explained what they would do if they thought that it had occurred.

When we arrived at the home we found that the hallway area next to the kitchen had an unpleasant odour of urine. We were told that the carpet is cleaned on a regular basis. However, this measure had not resolved the issue and the odour persisted.

Comments and complaints were listened to and acted upon. We spoke to a personal care worker who said, 'Issues or little niggles are dealt with straight away so the residents and relatives stay happy.'

We found that some people's dignity had at times been compromised due to staff misjudging some aspects of their support needs.

We found that people's health needs were met by accessing a range of health professionals in a timely manner.

People told us they liked the meals provided. Main meals were well presented and snacks and drinks were available in between meals. We found that, although there was enough staff to support people at mealtimes this did not appear to be effectively organised.

We found some areas of the home had odours and were in need of cleaning.

We found that medicines were managed so that people received their medicines as prescribed.

Staff had access to a range of training relevant to their role. They were supervised by more senior staff and supported by a management structure. Two separate occasions when staff were overheard using inappropriate language in the course of their day to day work had been addressed by the manager.

Both relatives told us they had completed questionnaires in the past about the quality of the service. We found that some daily monitoring was required to ensure a quality service was maintained.