Longview

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 inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to safety concerns and took appropriate action by investigating and reporting events. Lessons were learnt to continually identify and embed good practice. The registered manager shared learning with staff from incidents, accidents, complaints and safeguarding so that the service could continually improve and develop positive outcomes for people. Information was shared with staff through handovers, supervisions and staff meetings.

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. Before people came to live at the service the registered manager completed a full assessment of their needs to ensure they could be met by the service. People and their relatives had an opportunity to visit the service before they moved in to see if it was a place they would like to live. The registered manager liaised with other healthcare professionals to ensure people’s healthcare needs continued to be supported. A relative told us, “We had an assessment completed before [relative] moved into the home. They asked us questions to get to know [relative]. We are fully involved in the care plan and any reviews.”

The service 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 service shared concerns quickly and appropriately.
Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people. This action included informing other agencies if they were concerned about action being taken. A staff member told us, “I would report to my manager, and I would escalate to local authority if I needed to.”
We received positive feedback from people and relatives. A relative told us, “The staff are friendly which helps us when we come in to be more at ease. They keep us well informed, so we know [relative] is safe and well looked after, [relative] seems happy with the staff here, which means [relative] trusts them to keep [relative] safe.” Another relative told us, “I have no concerns over safety. My loved one is well looked after and there is always plenty of staff on duty when I visit.”
 

The service worked with people to understand and manage risks using a holistic approach. Staff provided care that was safe, supportive, and enabled people to do the things that mattered to them. Risks were clearly identified and appropriate safeguards put in place to mitigate them. For example, when people were at risk of developing pressure ulcers or experiencing falls, staff ensured appropriate equipment was in place and worked with individuals to reduce these risks. Staff also promoted preventative measures, such as encouraging people to remain well hydrated and nourished to reduce the risk of infections or skin breakdown. People were supported to live full lives, including safely accessing the community.
There was also clear guidance in place for staff to support people with specific health needs such as, diabetes. This included actions to take in the event of out-of-range high or low blood glucose levels, enabling staff to recognise changes in people’s conditions and respond appropriately to ensure safe and effective care.
Personal emergency evacuation plans (PEEPS) contained all the information staff, and the fire service may need to evacuate people safely in the event of a fire.
 

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The environment was adapted to meet the needs of people living there. There were spacious living areas offering people plenty of room to relax and engage in activities comfortably. Additionally, people had access to outdoor spaces, providing an opportunity to enjoy fresh air and relax in the gardens. People had their own rooms and specialist equipment was provided as needed. Maintenance staff were employed to ensure the premises were well-maintained and safe. There were systems in place to ensure any maintenance needed was recorded and responded to promptly.

The service made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. Staff worked well together to provide safe care that met people’s individual needs. The registered manager had processes in place to ensure all staff received an induction, and staff told us this was thorough and supportive. The provider was in the process of further developing and improving the induction programme to strengthen staff preparation for their roles.
Appropriate pre-employment checks were completed before staff started work, including full employment histories, references and Disclosure and Barring Service (DBS) checks, to support safer recruitment decisions.
Staff completed an induction and probationary period, with ongoing training opportunities available to develop their skills. This included both mandatory and face-to-face training in areas such as moving and handling. A structured supervision system was in place, with staff receiving regular one-to-one supervision every 3 months. In addition, observations of practice were carried out to ensure staff maintained expected standards and delivered safe, effective care.
A health professional told us, “I have discussed staffing with the management of the home, as although they are exceeding hours required according to the dependency tool, the size and shape of the home does make it difficult for some areas to be supervised. This has been resolved by the manager and the regional operations director through a re-deployment plan and reviewing day shift hours. Supervision in communal areas has improved.”
Another health professional told us, “From my observations, there appear to be sufficient staff available during my visits to support residents and meet their day-to-day needs. The staff team appear committed to providing a caring and professional service. Staff appear knowledgeable about the residents they support and work together well as a team.”
However, another health professional told us, “From my experiences the care home tries their best to provide a safe service to those living within the care home. Longview have a large number of residents who have complex health needs that requires a lot of input and support from health care professionals. Respectfully, the carers are not trained health care professional and sometimes struggle to highlight concerns regarding residents promptly. I have experienced some patients who are approaching end of life being admitted into Longview. I do have concerns that the care home is not always well equipped to manage these patients.” The registered manager told us they were working closely with health professionals to strengthen staff knowledge, develop staff practice and ensure people’s complex needs could be appropriately supported.
 

The registered manager 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 received training in infection and prevention control and the provider had policies in place for staff to follow, should there be any outbreaks of infectious diseases. The service had regular cleaning schedules in place and staff had personal protection equipment (PPE) available for their use. Both the registered manager and deputy manager carried out regular checks and audits to monitor the cleanliness of the service. However, these audits were not always consistently signed off when actions had been completed. Following the inspection, the registered manager took action to strengthen oversight and updated the audit process to ensure actions were clearly recorded and signed off once completed.
The registered manager had reviewed staffing arrangements and made changes to rotas, including employing additional domestic staff. This ensured that each bedroom received a weekly deep clean, further strengthening infection prevention and control measures within the service.
 

The service did not always have effective systems in place to ensure the safe and appropriate management of medicines. Medicines ordering was not fully under the control of the service, as this was managed by the GP practice. This was not in line with NICE SC1 guidance, which states that care homes should retain responsibility for ordering medicines. The registered manager told us they had arranged a meeting with the GP practice to address the concern. This resulted in inconsistent stock management, including over-ordering of some medicines such as insulin.
Returned medicines were not always recorded at the time of disposal, which goes against best practice and creates a risk of medicines being diverted.
Medicines were not always administered in line with best practice guidance. Administration times were not consistently recorded for time-sensitive medicines, such as paracetamol, meaning safe dosing intervals could not always be assured. Administration instructions for some medicines were not always being followed. A medicine that must not be given with other medicines was consistently being administered with another medicine which may lead to the medicine not being effective.
There were gaps in the review and monitoring of medicines. We found examples of topical medicines being administered beyond their prescribed duration, indicating that review processes were not always effective.
During the inspection, the service responded promptly to the concerns identified. Immediate action was taken to address issues relating to medicines timing, including the introduction of time sheets for paracetamol and clear guidance medicines with special instructions.
Medicines were stored securely, and temperature monitoring for medicines rooms and fridges was completed and within recommended ranges. Controlled drugs were managed in line with legal requirements, with registers maintained and regular stock checks completed, demonstrating safe handling and accountability.
There were effective systems in place for the receipt and reconciliation of medicines. Medicines were checked on delivery by trained staff and cross-referenced against MAR charts, with processes in place to address any discrepancies with the supplying pharmacy. Staff had access to regular support from healthcare professionals, including GP ward rounds, nurse practitioners and clinical pharmacist input, which supported safe prescribing and medicines review.
Medicines audits were undertaken regularly and included checks of MAR charts, stock balances and storage. Staff followed safe administration practices and demonstrated awareness of people’s individual needs during medicines rounds. Care plans contained relevant information to support the safe management of medicines, including guidance for long-term conditions such as diabetes, epilepsy and the use of anticoagulants.
Additional guidance was available to support staff, including information on medicines and protocols for managing specific risks such as hypoglycaemia. PRN protocols were in place and provided clear instructions for use, including indications and maximum doses. Systems were also in place to support safe transfer of care, including sharing medicines information during hospital admissions and discharges. Staff had completed medicines training and competency assessments, which were monitored to support safe practice.