Longroyds and Pilling House Care Home

Longroyds and Pilling House Care Home is a residential care home providing personal care for up to 52 people aged 65 and over. At the time of the inspection, 30 people were living at this service.

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

People’s medicines were not robustly managed as morning medicines had been administered late on the day of the inspection. Staff were administering prescribed laxatives, but not using records effectively to cross reference the effects of this medicine and whether it was appropriate to continue administering. This was addressed by the management team following our inspection.

Staff had a visible presence in the home and rotas showed shifts were fully staffed. The provider reviewed people’s dependency levels regularly. A recruitment check was not recorded as having been followed up, which meant the process was not robust.

Mental capacity assessments had been completed, although one person’s assessments raised queries which we discussed with the management team. 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.

People and relatives felt confident staff were suitably trained. The provider had identified training gaps before our inspection and was ensuring this improved. Staff said they were well supported, but they did not receive regular formal supervision support in 2022. This was addressed following our inspection.

Infection control was mostly well managed, although we noted occasions when staff were not wearing face masks correctly. Three relatives said they were not allowed to visit the home during an infection outbreak, despite having essential care giver status.

People and relatives felt safe at this care home and staff knew how to recognise and respond to signs of abuse.

Most people had a positive mealtime experience. We saw staff assisting people in line with their dietary needs. People were supported to have enough to eat and drink.

We have made a recommendation about support at mealtimes for people who may experience memory loss and have difficult making choices from the menu.

Staff worked with a range of healthcare partners and were able to spot the signs of ill health. Visiting healthcare professionals provided positive feedback about the care staff provided.

A range of quality checks were taking place in the home, although the provider needed to ensure timescales and completion of actions were clearly recorded. This had been identified by the provider before our inspection. The regional manager was closely involved with the running of the home and visited regularly.

Opportunities to provide feedback were being explored as there had been a limited number of meetings for people and relatives. Satisfaction surveys had been carried out, but it was not clear how negative feedback had been responded to.

Relatives said they felt they were kept informed about important issues. People we spoke with said they were well cared for. Staff told us they worked in an environment where the team worked well and there was a positive culture. Examples of lessons being learned and continuous improvement were evident at this inspection.

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 17 August 2021).

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the safe management of risks to people. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Longroyds and Pilling House Care Home on our website at www.cqc.org.uk

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will work alongside the provider and local authority to monitor progress at this service. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Longroyds and Pilling House Care Home is a residential care home providing personal care for up to 52 people aged 65 and over. At the time of the inspection, 31 people were receiving care on the first day of our inspection and 27 people on the second.

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

Risk was not always identified and managed in the environment as some areas had not been made safe or secured. This also meant there was missed opportunity for learning following an incident. We have made a recommendation about further embedding risk management in practice. People felt safe and staff knew how to support people safely and meet their needs. There were enough staff and systems were in place to ensure they were recruited safely. Medicines were managed and systems were in place to prevent and control infection.

Improvements plans were being implemented by the registered manager and provider to address risk management, the environment and training. Record keeping for mental capacity assessments and best interest decisions had been addressed following the previous inspection and the service was no longer in breach. Systems where in place to monitor the quality and safety of the service and people’s feedback was sought to drive improvement. The management team and staff worked well together and had developed partnerships with other services and organisation to improve outcomes for people.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 8 June 2019). 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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.

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about risk management in the environment. This inspection examined those risks. 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 remained requires improvement. This is based on the findings at this inspection.

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

We found no evidence during this inspection that people were at risk of harm from this concern. Improvements were made during and following the inspection by the registered manager and provider. Please see the safe and well-led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Longroyds and Pilling House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Longroyds and Pilling House Care Home provides accommodation and personal care for up to 52 older people, some of who are living with dementia or have mental health needs. The service is located in two separate houses; Longroyds can accommodate up to 18 people and Pilling House up to 28 people. There are also five flats and one bungalow next to Pilling House which can accommodate up to six people. At the time of our inspection there were 39 people living at the service.

People’s experience of using this service:

We found one breach of the regulations in relation to the mental capacity act. The provider was not always completing decision specific mental capacity assessments and best interest meetings.

We have made a recommendation about the management of some medicines.

People told us they felt safe.

Staff were being recruited safely and there were enough staff to take care of people. Staff were receiving appropriate training. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs. Staff received yearly performance appraisals.

People enjoyed the meals and their dietary needs had been catered for.

Records showed people had regular access to healthcare professionals to make sure their health

care needs were met.

People and relatives felt staff were kind and caring and treated them with dignity and respect when providing care.

A complaints procedure was in place. People and relatives told us they would have no hesitation in raising concerns.

Everyone spoke highly of the registered manager who they said was approachable and supportive.

Rating at last inspection:

At the last inspection the service was rated ‘good’ (report published 14 October 2016). At this inspection the service was rated ‘requires improvement’ overall, with two out of the five key questions rated as good.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We have requested an action plan from the service to tell us how they intend to make improvements. We will inspect the service again within twelve months.

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

The service provides accommodation for persons who require nursing or personal care (without nursing) for up to 52 older people, some of whom are living with dementia or other mental health problems. The service is located in two separate houses; Longroyds can accommodate up to 18 people and Pilling House up to 28 people. There are also five flats and one bungalow next to Pilling House which can accommodate up to six people. Both Longroyds House and Pilling House have adequate outdoor areas for recreation and parking. The overall feeling of the location is one of a small 'hamlet' with two converted old mill owner's houses, a converted stable block and views across rolling countryside.

The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for over 15 years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed on an individual and group basis to minimise the risk of injury or harm.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s needs and we saw that rosters corresponded with the staff that were on duty on the day of the inspection. Recruitment policies, procedures and practices were carefully followed to ensure staff were ‘fit’ to care for and support vulnerable people. We found that the management of medication was safely carried out.

People were cared for and supported by qualified and competent staff that were regularly supervised and had their personal performance appraised. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Staff were knowledge about and understood their roles and responsibilities in respect of the Mental Capacity Act 2005 (MCA). Staff understood the importance of people being supported to make decisions for themselves. The regional manager explained how the service worked with other health and social care professionals and family members to ensure a decision was made in a person’s best interests where they lacked capacity to make their own decisions.

People received adequate nutrition and hydration to maintain their health and wellbeing. The premises were suitable for providing care to older people, and to people living with the early stages of dementia, but not for those people living with a more advanced dementia. This was acknowledged by the registered provider.

We found that people received compassionate care from staff that were kind. Staff knew about people’s needs and preferences and met these. People were involved in all aspects of their care and were always asked for their consent before care and support tasks were undertaken.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked hard to maintain these. This ensured people were respected, that they felt satisfied and were enabled to have control of their lives.

We saw that people were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. People had ample opportunities to engage in pastimes and activities in order to pass the time of day and maintain their levels of cognition and dexterity. There was an impressive range of pastimes, games, crafts and outings, which were all arranged and facilitated by an activities coordinator who had very good connections within the local community. People had very good family connections and support networks and so had the opportunity to go out with and be visited by family and friends.

We found that there was an effective complaints procedure in place and people had their complaints investigated without bias. People that used the service, relatives and their friends were encouraged to maintain healthy relationships together through regular visits, telephone calls and sharing of each other’s news.

We saw that the service was well-led and that the culture and management style of the service was positive. There was an effective system in place for checking the quality of the service using audits, satisfaction surveys, meetings and different communication methods.

People had opportunities to make their views known through direct discussion with the registered provider or staff and through more formal complaints and quality monitoring formats. People were assured that recording systems protected their privacy and confidentiality as records were well maintained and were held securely in the premises.

' Supporting workers.

' Records.

The inspection visit was carried out by two inspectors. During the inspection, they spoke with the regional manager, administrator, a team leader, two care staff and the activities co-ordinator. We also spoke with four people who lived at the home and two relatives. The inspectors also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

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

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

People were cared for in an environment that was clean and hygienic.

People were treated with respect and dignity by the staff.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

One person who used the service said, 'I feel safe.'

Is the service effective?

We looked at four people's care records, we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

We saw a programme of supervision was in place for staff.

We saw there were plans in place to ensure mandatory training requirements were met.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care assistants were patient and encouraging when supporting people.

People's preferences, interest and needs had been recorded and care and support had been provided in accordance with people's wishes.

One visitor told us, 'The staff are all nice. They can't do enough for us and mum loves them too.'

Is the service responsive?

People had access to activities and were supported to maintain relationships with their friends and relatives.

We saw from the care records that people's needs had been assessed before they moved into the home. The care, treatment and support provided at the home met their individual needs.

Is the service well-led?

The registered manager has been in post since 2011.

We saw that the senior management team were developing more robust quality audits and taking action to improve the service for people.

The service acted upon comments and suggestions made at service user meetings.

The manager explained that the maximum number of residents the home could accommodate was actually 46. This was because six larger rooms in Pilling House were originally for two people and the home now used them for single occupancy.

We looked round the two homes and saw that the accommodation was clean, tidy and generally well-maintained. We noted some areas that were in need of repair; the manager told us they were aware of these and that refurbishments at the homes were ongoing. We looked in six people's bedrooms in the two houses and saw that people's bedrooms had been personalised and contained items such as photographs and soft toys. People appeared well-dressed and well cared-for.

We looked at four people's care records and saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

The activities co-ordinator we spoke with told us, 'I'm a big advocate for this place; it's a privilege to work here. I've worked at a lot of care homes and this one is very good.'

One person who uses the service said "If I needed assistance I'd go and find some staff. My clothes are washed for me and I chose what I want to wear and the carers help me to get dressed".

During our visit we found evidence that showed staff training was not currently up to date. We also noted that some people's care records were not up to date and fit for purpose. We have asked the provider to make improvements in these areas.