Longcliffe Care Home

Longcliffe Care Home is a residential care home providing personal care to up to 42 older people and people with physical disabillities. At the time of our inspection there were 18 people using the service. The accommodation is over two floors of a large period property with bedrooms on the first floor serviced by a lift. The lift was out of use at the time of our inspection.

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

People's medicines were not managed or administered safely. We found a number of medicine errors which had not been identified through the provider audits and which indicated people had not received their medicines as prescribed.

People were not protected from the risk of abuse or improper treatment. People who had made allegations of abuse, or actually experienced abuse, did not receive the support they needed in a timely way. The provider had not taken timely preventative action, including escalating safeguarding concerns to relevant external agencies. This placed people at significant and prolonged increased risk of harm. The provider did not consistently ensure all staff were suitably qualified, competent, skilled and experienced to be able to meet people's needs. People had confidence in most staff but felt other staff were not as willing or able to meet their needs.

The provider had quality assurance processes in place, but these were not used effectively to assess, monitor and improve the service. Audits and checks had failed to make sustainable improvements and we were concerned that full oversight had not been established. Concerns we identified at this inspection had not been identified by the provider's own systems. This is the sixth consecutive rated inspection where the provider has failed to meet regulations and achieve a good rating as a minimum standard.

People were protected from the risk of infections. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We observed people being offered choice during both days of inspection, and people told us they were offered choice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 January 2023) and there was a breach of Regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of safeguarding people from abuse and improper treatment. This inspection examined those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for this service has changed from requires improvement to inadequate based on the findings of this inspection.

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, safeguarding people from abuse and improper treatment, staffing and good governance.

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

The overall rating for this service is ‘Inadequate’ and the service is 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 time frame 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.

Longcliffe care home is a residential care home providing personal care to 19 people at the time of the inspection. The service provides support to older people, some of whom may be living with dementia. The service is registered to support up to 42 people in one building that has been adapted to support people's needs.

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

People were not always given their medicines safely and as prescribed. Improvements were needed to ensure medicine records accurately reflected stock levels and medicines administered. Additional improvements were needed to ensure medicines were stored safely.

Interim management arrangements that were evident at our last inspection remained in place. There was no registered manager. Following our inspection, the registered provider appointed to this post and began the relevant registration processes with the Care Quality Commission.

Staff were aware of their responsibilities regarding safeguarding. Risks to people, staff and within the service were managed. There were person-centred risk assessments and care plans in place. Accidents and incidents were well managed. There was detailed records of events, analysis and lessons learned.

There were safe systems of recruitment in place. The registered provider had a number of staffing vacancies. To ensure consistency, they relied on regular agency staff to ensure sufficient numbers of staff were available to meet people's needs. The service had improved infection prevention and control standards within the service.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to have enough to eat and drink and maintain their health and well-being. Staff worked with a range of health care professionals. Staff completed training and received support and guidance to give them the skills and knowledge they needed in their roles.

People had access to a wide range of activities to keep them active, involved and stimulated. People and their relatives felt able to raise any concerns. People were enabled to plan their end of life care in line with their wishes and preferences.

The registered provider had made improvements to the systems in place to monitor the quality and safety of the service. People, their relatives and staff were positive about the management of the service. People liked living at the service and commented positively about the staff team. Staff said morale had improved and were committed, caring and attentive to the people they supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was requires improvement (published 28 October 2021) and there were breaches of regulations. Although the provider had made some improvements, they remained in breach of regulations.

This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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 and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment. Please see the action we have told the provider to take at the end of this report.

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.

Longcliffe Care Home is a residential care home providing personal care and accommodation for up to 42 older people or people with physical disability. At the time of our inspection, there were 17 people using the service.

We found the following examples of good practice.

The provider had ensured a sufficient stock of personal protective equipment (PPE) was available to staff. PPE was available in stations placed outside rooms where people were isolating and at PPE stations across the service. This ensured staff had access to PPE when it was required. We observed staff donning and doffing PPE safely and changing PPE when moving between rooms and supporting people.

The service was clean with frequent cleaning of high touch areas. Cleaning standards were monitored by the management team through daily walk rounds and infection prevention and control audits and checks.

Staff and people were regularly tested and had received COVID-19 vaccinations. We found one contractor was entering the premises without COVID-19 vaccinations. The provider took immediate action and stopped this person working in the service pending outcome of the governments proposal to revoke vaccinations as a condition of employment.

Longcliffe care home is a residential care home providing accommodation and personal care for up to 42 older people some of whom had physical disabilities. At the time of the inspection 16 people were using the service.

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

People's risk assessments required improvement. Records were not always updated to reflect people's current needs and information within records was contradictory. This meant staff may not have the information they need to provide safe care.

Some infection control practices did not mitigate the risk of contracting and spreading COVID-19 within the care home. Staff were observed not wearing appropriate personal protective equipment when supporting people with medicines and failing to wear face masks or ensure these were fitted correctly. Medicines were not always administered safely.

People were protected from abuse. However, the provider had not always submitted notifications of serious incidents and accidents to the Care Quality Commission. This meant we could not ensure timely action had been taken to keep people safe.

Oversight of the service required improvement. Not all concerns found on inspection had been identified through the providers' audits and checks.

Staff were safely recruited to ensure they were suitable to work in the staff. The provider had implemented contingency planning to ensure sufficient numbers of staff were deployed to meet people's needs.

People and their relatives felt the service was safe and provided personalised care. People and relatives gave examples of positive outcomes as a result of the care provided. Staff felt supported and engaged in the service. The management and staff were open and transparent throughout the inspection. They agreed to ensure changes were made to improve the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (Published 25 August 2018)

Why we inspected

The inspection was prompted in part due to concerns received about care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Longcliffe care home on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Longcliffe nursing home is a care home providing accommodation for up to 42 older people, including people living with dementia and physical disabilities. At the time of the inspection there were 17 people using the service.

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

Prior to the inspection we received information that staff were not following safe practices in wearing personal protective equipment (PPE). We found staff were wearing fluid repellent face masks when supporting people with personal care. However staff were wearing cloth face masks when interacting with people in communal areas. Government COVID-19 guidance around PPE in care homes does not recommend the use of cloth face masks for staff delivering health and care activities. The provider immediately addressed this during our inspection visit.

We found people were protected from the risk of acquiring infections and the service was clean. Personal protective equipment was readily available to staff. People and staff were supported to undertake regular testing and robust visiting arrangements were in place to enable people to receive visitors and essential health care. The provider's infection prevention and control policy required updating to reflect current government guidance around the management of risks associated with COVID-19.

Longcliffe Nursing Home provides personal care and accommodation for up to 42 older people some of whom have dementia. On the day of our inspection there were 26 people living at the service.

At the last inspection in October 2017 we found two continued breaches of the regulations. The service was rated overall Requires Improvement with an Inadequate rating in the Well led domain and a Requires Improvement rating in the Safe, Effective and Caring domains. The service was placed in special measures.

We inspected again on 24 and 25 July 2018. The first day of our visit was unannounced. This meant the staff and the provider did not know we would be visiting. During this inspection we found the provider had implemented the necessary improvements. At this visit we found evidence to demonstrate and support the overall rating of Good. The service is no longer in special measures.

The service 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 2008 and associated Regulations about how the service is run.

People told us they felt safe living at Longcliffe Nursing Home. The staff team had received training on the safeguarding of adults and were aware of their responsibilities for keeping people safe from avoidable harm.

People's care and support needs had been identified and the risks associated with their care and support had been assessed and reviewed. Plans of care had been developed for each of the people using the service and the staff team knew the needs of the people they were supporting well.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong to improve safety across the service.

Checks had been carried out when new members of staff had been employed to check they were suitable to work at the service. Staff members had received an induction into the service and relevant training had been provided enabling them to properly support the people using the service.

People told us the staff team were kind and caring and treated them with respect. Observations made during our visit confirmed this.

The staff team supported people to make decisions about their day to day care and support and always obtained people’s consent to their care. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

Whilst people were provided with their medicines safely, GP instructions had not always been followed. Protocols were in place and followed with regards to medicines prescribed ‘as and when required’.

The staff team had received training on infection control and followed best practice guidance in preventing the spread of infection. We saw personal protective equipment such as gloves and aprons were readily available and these were used by the staff team throughout our visit.

Most areas of the service were clean and tidy.

People's food and drink requirements had been assessed and a balanced diet was being provided. People received on-going healthcare support and had access to the relevant healthcare services.

Staff members felt supported by the management team and told us there was always someone available to talk with should they need guidance or support.

People knew who to talk to if they had a concern of any kind. A formal complaints process was in place and people were confident that any concerns they had would be taken seriously and acted upon.

Relatives and friends were encouraged to visit and they told us the staff team made them welcome at all times.

People were provided with the opportunity to have a say and to be involved in how the service was run. Regular meetings had been held and surveys used to gain people’s feedback.

There were systems in place to monitor the quality and safety of the service being provided and a business continuity plan was available to be used in the event of an emergency or untoward event.

Further information is in the detailed findings below.

At our last inspection on 3 and 6 February 2017 we found two breaches of legal requirements and rated the service as Requires Improvement. After this inspection the provider wrote to use to say what they would do to meet legal requirements in relation to a breach in Good governance and Requirement as to display ratings. At this inspection we found the service had made some of the required improvements. However the rating for the service remained Requires Improvement. We found two continued breaches of the regulations.

Longcliffe Nursing Home provides accommodation, care and support for up to 42 people who require personal care. During our inspection 18 people were using the service. The home is located on two floors with lift access to both floors.

The service 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 2008 and associated Regulations about how the service is run.

People’s equipment was regularly checked, however actions to repair equipment were not always carried out. Audits on the environment had not always been recorded to show checks had been completed. There were plans to keep people safe during significant events such as a fire.

People were protected from the risk of harm because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to report any concerns they had about people’s welfare.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where risks had been identified control measures were in place.

There were enough staff to meet people’s needs. People sometimes had to wait for support however staffing levels had been assessed and staff could respond to people’s requests for support. The provider had safe recruitment practices. This assured them that staff had been checked for their suitability before they started their employment.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. Staff had been trained to administer medicines and had been assessed for their competency to do this.

Staff received appropriate support through an induction, support and guidance. There was an on-going training programme to ensure staff had the skills and up to date knowledge to meet people’s needs.

People received enough to eat and drink. Records of what people had eaten were not accurately recorded. They had access to a variety of meals, snacks and drinks.

People’s health needs were met. This is because staff supported them to access health care professionals promptly. Staff also worked with other professionals to monitor and meet people’s needs and support them to remain well.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that assessments of mental capacity had been completed; however these had not been reviewed and were not always based on a specific decision. Staff told us that they sought people’s consent before delivering their support.

People were involved in decisions about their support. They told us that staff treated them with respect, however there were times when people were not always treated with

dignity. Staff usually treated people with kindness and compassion.

People received care and support that was responsive to their needs and preferences. Care plans provided information about people so staff knew what they liked and enjoyed. People were encouraged to maintain and develop their independence. People took part in activities they enjoyed. People did not always participate in reviewing their care plans.

People and their relatives knew how to make a complaint. The provider had a complaints policy in place that was available for all.

People and staff felt the service was well managed. The service was led by a registered manager who understood most of their responsibilities under the Care Quality Commission (Registration) Regulations 2009. Staff felt supported by the registered manager.

Systems were in place which assessed and monitored the quality of the service. These had not always been recorded and did not always identify areas for improvement. People were asked for feedback on the quality of the service that they received.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We identified that provider continued to be in breach of two of the Regulations of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the end of this report.

Longcliffe Nursing Home provides accommodation, care and support for up to 42 people who require personal care. During our inspection 24 people were using the service. Since our last inspection on 6 June 2016 the provider had chosen to no longer provide nursing care at Longcliffe Nursing Home and had deregistered this regulated activity in October 2016. The home is located on two floors with lift access to both floors. The home has two communal lounges and a dining room. During our inspection the lounge upstairs was in the process of being decorated so was not in use.

The service 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 2008 and associated Regulations about how the service is run.

At the last inspection we carried out on 6 June 2016 we found that the provider had not met the regulations relating to good governance. At the inspection we found the provider had made some of the required improvements.

People were not always protected from risks relating to their health and safety. We found that not all risks had been fully assessed and control measures identified.

People were protected from the risk of abuse because staff could identify the potential signs of abuse and knew how to report any concerns. Accidents and incidents were recorded and reviewed to identify the cause to try and reduce the risk of reoccurrence.

Staff had not always been recruited safely. Pre-employment checks had not been thoroughly carried out before staff started to work at the service. These are important to make sure that staff are suitable to work with people who may be vulnerable. There was enough staff to keep people safe.

People’s tablets and liquid medicines were stored safely. Where medicines were taken as and when required these had not been given in accordance with the protocol in place. Creams and liquids had not always been dated when opened.

Staff received support through an induction to the service and supervision. There was an on-going training programme to provide and update staff on safe ways of working. We found staff had not all completed training to give them the guidance and knowledge to meet the needs of people who used the service.

People were supported to access healthcare services. People were given sufficient to eat and drink. Where people’s food intake needed to be monitored to reduce the risk of malnutrition the amount of food people had been given was not recorded. Where people had a specific diet this was not always followed.

People were usually asked for their consent before staff supported them with personal care. Where there was a reasonable belief that someone did not have the capacity to make a specific decision an assessment of their capacity had sometimes been completed. Where a decision had been made that was believed to be in a person’s best interests the details of this had not been recorded.

People told us that the staff were kind. Staff members knew people well and were able to tell us about their likes and dislikes. Staff did not always pass private information to other staff in a discreet manner. Staff did not always respect people’s choices in relation to their likes and dislikes.

Relatives and friends were able to visit when they wanted to and were made to feel welcome.

People took part in a range of activities that they enjoyed. Some people told us that they would prefer some other activities.

People had contributed to an assessment of their needs when they started to use the service. They had given information about their likes, dislikes and personal history. People had not been involved in the reviews of their care plans to make sure that information about them was current.

People and their relatives knew how to raise concerns. They did not always feel that these were listened to. People had attended meetings to discuss the service and to ask their thoughts on this.

Records relating to people’s care were not fully completed and had not been updated to reflect changes even when they had been reviewed. The records did not reflect all care that was given. We found that checks that had been implemented to monitor this had not been completed effectively in order to identify that this had not been recorded.

Policies and procedures that give staff guidance on how to carry out their roles were not available at the time of our inspection as they were being updated.

The provider had implemented systems and processes to monitor and improve the quality of the service that had been provided. These did not identify concerns that we found during this visit.

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

Longcliffe Nursing Home provides both personal and nursing care for up to 42 people who are aged over 65 and who may also have a physical disability. The home is located on two floors with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 25 people were using the service.

We carried out an unannounced comprehensive inspection of this service on 14 and 15 December 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to a breach of Regulation 12 safe care and treatment, and a breach of Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Longcliffe Nursing Home on our website at www.cqc.org.uk.

The home does not have a registered manager in place. 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. A manager was appointed in June 2015 and was in the process of making an application to the Care Quality Commission for registration.

At the last inspection we carried out on 14 and 15 December 2016 we found the provider had not met the regulations relating to the safe care and treatment of people who used the service and good governance. At this inspection we found the provider had made some of the required improvements.

We were concerned that records relating to peoples care were not always fully completed. We saw that records did not show all care that had been given and showed large gaps where people may not have received any care. We found that checks that had been implemented to monitor this after the last inspection had not been continued and the records were still not recording care that people had received.

People were protected from most risks relating to their health and safety. Risks had been assessed and people were now protected from the potential risks of hot radiators and hot water. Radiator covers had been put in place and checks were being carried out on the temperature of the water. We found that risk assessments had been reviewed monthly. However, we found that risks associated with Legionella had not been assessed. Actions that had been identified had not been put in place. Tests that can reduce the risk of Legionella had been carried out but had not been recorded. We found that the provider had not had the water tested for Legionella.

People had most of their needs assessed when they moved to the service. Risk assessments had been completed around the risk of someone falling and control measures were put in place very soon after the person had started to use the service. A checklist had been implemented to make sure that appropriate assessments were completed. However, we found that needs in the case of an evacuation had not been assessed. We also found that people’s care needs had not been fully assessed and they did not have a care plan that told staff how to support the person with all of their identified needs.

We found that where healthcare equipment was used it was being cleaned regularly in line with guidelines for the equipment and this had been recorded.

We found that medicine to be returned to the pharmacy had not been stored safely and had been stored in an unlocked room. This meant that anyone had access to this medicine.

We found that audits were generally being completed on a scheduled basis. These had identified areas for improvement and we saw that this work had been completed.

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

Longcliffe Nursing Home provides both personal and nursing care for up to 42 people who are aged over 65 and who may also have a physical disability. The home is located on two floors with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 25 people were using the service.

The home does not have a registered manager in place. 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. A manager was appointed in June 2015 and was in the process of making an application to the Care Quality Commission for registration.

At the last inspection we carried out on 29 April 2014 we found the provider had not met the regulations relating to the management of medicines. At this inspection we found the provider had made the required improvements.

People told us that they felt safe and that they enjoyed living at the Longcliffe Nursing Home.

People were not consistently protected from risks relating to their health and safety. Risks had not always been assessed. People were not protected from the risks of potentially dangerously hot radiators and water. Checks in place had not identified the risk of the hot radiators. Checks had identified that the water was very hot but action had not been taken to remedy this.

People received their medicines safely and at the right time. Records contained important information about medicines that people were taking. We found that temperatures were not recorded in the controlled drugs cabinet. Creams and eye drops were not always dated when they had been opened. This meant that there was a risk that important medicines would not be effective and could harm people.

Staff were supported through training to be able to meet the care needs of the people they supported. We found that not all training was in date, and supervisions were not taking place regularly.

Staff told us that they sought people’s consent prior to providing their care. We saw that appropriate assessments had taken place.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity.

People did not always receive the care they needed at the times they wanted it. We saw that staff were not always responsive to people when they asked for support.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

We were concerned that records relating to peoples care were not always fully completed. We saw that records did not record all care that had been given and that there was a risk therefore that staff who did not know people well would not be able to deliver care safely in accordance with their needs.

We found that quality assurance systems were not effective and audits had not been completed when they were scheduled. The provider had not identified the shortfalls in quality that we found during this inspection. This meant that the provider was not able to ensure that people were receiving safe, effective, caring or responsive services that met their needs.

Staff told us that the found the management approachable and felt they were listened to.

We found two breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People told us that they felt safe living at Longcliffe and that they were treated well. One person explained: 'I feel very safe here; they look after me very well.' Another person told us: 'I'm as safe as I can be; the staff are very good, excellent.'

Risk assessments were in place. Those checked on the day of our visit showed us that the risks associated with people's care had been appropriately assessed and measures had been put into place to reduce that risk. This showed us that people's health and welfare was, wherever possible, protected.

Records kept to monitor how much food and drink people had consumed during each day were up to date and repositioning charts (used for people unable to move themselves in bed) showed us that people were being assisted appropriately. This showed us that people were protected from the risk of malnutrition and the development of pressure sores.

Staff spoken with knew what to do if they suspected that someone was being abused. One staff member explained: 'I would report it straight the way. ' Another told us: 'I would report it to the manager; if they weren't around I would refer it to the safeguarding authority.'

On checking the medication records we found that on one day, the registered nurse had failed to sign to say that they had dispensed two people's medicine.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the registered manager understood when an application should be made, and how to submit one. Not all of the staff spoken with were fully knowledgeable in this area

Is the service effective?

We spoke with people who used the service and they all told us that they were satisfied with the care and support they received. One person told us: 'I'm very happy here; they come when I ring my bell and that is important.'

Care plans provided staff with information about people's care and support needs and it was clear from our observations and from speaking with staff, that they understood the needs of the people they supported. One person told us: 'The staff are fantastic they know what to do, but always ask first.'

Is the service caring?

We observed staff going about their work in a relaxed and calm manner. They treated the people they were supporting in a kind and respectful way and provided them with the time that they needed in order to carry out a task, whether that was assisting people with their meals or assisting them to the toilet.

Everyone spoken with told us that the staff were caring and attentive. One person told us: 'They look after me very well.' A visitor explained: 'They are just lovely with them [the people who use the service] very patient.'

Is the service responsive?

People's needs had been assessed before they moved into the home and they and their relatives had been fully involved in the care planning process. One relative explained: 'They talked us through everything, the care plan and the process.'

Relevant professionals had been involved in people's care and records showed that visits were arranged whenever someone needed to be seen. This included visits from their GP, optician, dentist and the local speech and language team. This ensured that the people who used the service received the care and treatment they required.

Is the service well-led?

Staff had a good understanding of the ethos of the home. They felt supported by the management team and they explained that they were able to talk to the manager if they have a concern of any kind. Staff meetings were also held on a regular basis. This enabled the staff to have a say on how the service was run.

There was an appropriate quality assurance system in place. This enabled the manager to regularly assess the service to ensure that people were receiving the best possible service.

A complaints process was in place and complaints received had been thoroughly investigated. This showed us that complaints were taken seriously and action had been taken where necessary.

We were also able to speak with one relative and five members of the staff team. This enabled us to gain their views of the overall service provided. The relative told us: 'The staff are great, really friendly, and my relatives face lights up when she sees them.'

We looked at some care plans and found these to be up to date, but other records such as food charts and repositioning charts (used for people unable to move themselves in bed) had not been completed correctly.

When we checked the medication records we found that on three occasions medicines had been given but had not been signed for and one medicine had run out of stock.

At the time of our visit the premises were in the process of being refurbished. A number of areas had already been decorated including the first floor corridor and some of the bedrooms and a refurbishment plan was in place showing the areas to be refurbished in the next 12 months.

Staff told us that they had been appropriately trained and supported and this was confirmed when we checked the training records. One staff member told us: 'There is always training going on.'

Everyone spoken with explained that they were very happy with the care and support they were currently receiving and they told us that the staff were kind and helpful. One person told us, 'The staff listen; they are very, very good.'

People told us that they were treated with respect and care and support was provided in a dignified manner. One person told us, 'I am very much treated with respect; they are very good in that way.'

People told us that the food served at the service was good and a choice was always offered. One person explained, 'The food's alright, it varies, but it can't be perfect all the time, they can't please everybody.' Another person told us, "The food is good, there's a varied menu and you get plenty.'

We were told that people felt safe living at Longcliffe and felt able to speak with the staff should they have any concerns. One person told us, 'I would talk to one of the staff or the matron, they'd sort it.' Another person explained, 'I have no concerns, but if I did, I'd tell the manager.'

Staff working at Longcliffe told us how much they enjoyed working for the service. One staff member explained, 'I love it, it's nice to help people who can't help themselves and encourage people who can help themselves to do that little bit more.'