We carried out this inspection on 30 November and 2 December 2016. Both days of the inspection were unannounced.The service is registered to provide nursing care for up to 54 older people including people with a diagnosis of dementia. At the time of the inspection 47 people were using the service.
Our last inspection of this service was during December 2015 and we rated the service as requiring improvement overall. This was because we found the provider was not meeting the requirements in relation to safety and providing an effective service. We received an action plan from the service explaining how they would resolve these issues which we used to plan this inspection and check that the improvements had been made. At this inspection we found the provider had taken the necessary action to resolve the issues identified in 2015. However we identified errors with the recording of medicines so we were not assured people always received their medicines as intended. This aspect of the service requires improvement As a result of our inspection the service learnt from this situation and has increased the medicine audits from monthly to weekly and provided additional support to the staff involved
There was a registered manager at the service. 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.
Since our last inspection the manager and deputy manager both new at the time of the previous inspection have established themselves into their management positions. The provider identified the need for additional management support and has appointed a clinical lead nurse. An additional nurse has been rostered on each day time shift so there were two nurses on duty who were supported by team leaders and care staff. The service used a dependency tool to identify the number of staff required to be duty in respect of the needs of the people using the service We found there were adequate staffing for people’s identified needs.
Risks to people’s safety were adequately managed. The service assessed people’s risks of falls and monitored any falls that people sustained to identify any triggers and put additional safety measures in place. Staff had received training in managing risk and how to provide a safe environment for people. Regular environmental check were in place.
Staff received training in safeguarding and were aware of what actions they should take to safeguard people from potential, actual abuse and knew what actions to take to promote people’s safety and well being.
There was a robust staff recruitment policy and procedure in operation. This helped to ensure only suitable staff were employed. Once employed staff were supported by an induction and regular supervision was provided by the senior staff. Training was provided to develop and maintain staff skills including the nursing staff who were all working upon revalidating their qualification.. All nurses are required to do this by their governing body the Nursing and Midwifery Council, (NMC) The management team were supported by regular visits from the provider. The provider had also enlisted the support of Consultant to provide training to all staff and work with the management team for the smooth running of the service.
There were suitable arrangements for the safe storage, management and disposal of medicines. However we did identify two recording errors of people’s medicine which we brought to the attention of the deputy manager.
The senior staff of the service were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had made referrals and worked with the Local authority to support people who used the service with regard to (MCA) and (DoLS).
Deprivation of Liberty and best interest assessments were in place to provide staff with guidance to protect people where they do did not have capacity to make decisions and where there freedom had been restricted for their own safety.
People had their nutrition and hydration needs met through effective planning and development of nutritious menus. Menus were varied and took into account people’s dietary preferences.
The service had built up an effective and supportive relationship with the general practitioner service
Prior to coming to the service people and their families were given information to assist them to decide if Longmead Court was an appropriate place for them while an individual needs led assessment was carried out. This was to determine if the service could meet the person’s needs.
Each person had a care plan which was regularly reviewed to help staff provide care around their assessed needs. Other professionals involved with peoples care and families informed us the service staff worked with them and kept them informed appropriately
People’s privacy and dignity were respected by staff who were familiar with their needs and took into account how people wanted to be cared for. .
The service had a complaints procedure which was available for people to use if so required. People did tell us that they liked the activities but would have liked more.
Surveys were carried out by the service to identify how the service could continue to be improved. The senior staff also arranged staff meetings to inform and listen to the views of the service staff. People using the service relatives and staff told us that the management staff were approachable and supportive.