Longmead Court Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to the assessment of people’s mental capacity.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider completed initial assessments of people’s needs when they moved into the service. However, people and their relatives were not always fully involved in the process to ensure their needs were fully understood. A relative told us, “We don’t sit down with anyone and just talk about [Person]’s care”. Although a ‘this is me’ document had been introduced to capture people’s likes and dislikes to feed into the care planning process, these were not yet in place for everyone in the home. People’s assessments considered a range of individual risks, holistic needs and preferences; some care plans, for example communication care plans contained detailed, person-centred guidance, however we found care plans for mental health conditions required further strengthening, as they did not always include comprehensive information for staff to fully understand people’s specific needs for example triggers and signs or symptoms of anxiety.

Whilst some staff told us communication was effective when people moved into the service, stating, “As soon as the shift starts, a senior carer tells us [about the needs of new residents]. We discuss what the care plan is. We interact with the resident and look at the system, we go through the information.” Other staff said communication was, “Really poor”.

Although feedback was mixed regarding communication with the leadership team, people and their relatives told us care staff communicated effectively to maximise care and support. A relative of a person who was relatively new to the home said, “Most of the staff here do know [Person] well”. Where people were supported by unpaid carers, staff were aware as people’s care plans included information about people that mattered to them. A relative told us how the home had supported them in this role, they said, “I struggle sometimes because of the dementia – they [Staff] take all the pressure off me. They help me, too”.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

National tools were used to assess personal risks and plan people’s care and treatment in line with best practice guidance, for example the risk of weight loss, acquiring pressure injury, and experiencing falls. Care plans in place reflected the outcomes of these assessments. However, recording needed to improve to ensure daily notes reflected that people’s care and treatment was being provided in line with these assessed needs.

Where people had been assessed by speech and language therapy as requiring modified diets, staff across the service were aware of people’s specific needs and how to meet them, however, not all staff had received training in dysphagia and texture modification to ensure their knowledge remained up to date. People told us they had enough to eat and drink to meet their nutritional needs, however feedback was mixed in relation to the quality and variety of the food provided. Whilst one relative told us, “Fantastic. There is always a choice of 2 dinners, and they offer a sandwich if [Person] doesn’t like it. The breakfast is good”. A person residing at Longmead Court said, “Often the food is served cold, the quality of food is just not good”. Care plans included information about peoples assessed dietary needs so staff could support them safely, but recording needed to improve to ensure daily notes reflected that fluids were being provided in line with people’s assessed needs.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We received positive feedback from visiting professionals about their working relationships with the home. A visiting professional said, “We have good communication with the Clinical Lead, and we are contacted promptly should there be an issue affecting one of our patients”.

Care plans were updated to reflect guidance provided by healthcare partners to ensure care and treatment was in response to their most up to date needs.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Care plans included information about people’s regular appointments with other services to ensure ongoing physical health and wellbeing, for example with the dentist, hairdresser and chiropodist. Information included frequency of appointments and the level of support people required to attend these. We saw people walking in the outdoor spaces to get fresh air and retain mobility, improving overall wellbeing, physical health and supporting them to retain their skills and independence. Regular activities were arranged so people could enjoy access to mental and physical stimulation both in and out of the home. We observed people being supported by staff to engage in dancing during our inspection and relatives told us there were opportunities to venture out. A relative said, “They have called me to check they can take [Person] out”, and another told us, “[Person] went out to a coffee morning”.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We saw that whilst some clinical needs were closely monitored, for example weights and skin integrity, omissions and inconsistencies in care recording made it difficult to evidence how other needs were being monitored to ensure people’s needs were consistently being met. Improvements were needed when staff were recording people’s fluid intake to ensure this was sufficient to meet their hydration needs. The recording of nutritional intake was also difficult to monitor, as entries into the system were inconsistent. Although some entries gave a summary of what food had been eaten, others only noted which meal had been eaten, for example ‘had breakfast’ or ‘had a snack’, without a description of the meal itself so that nutritional intake could be monitored to prevent weight loss and associated health risks. Although catheter and continence care plans instructed staff in how to monitor urinary output for signs of infection, blockages and retention, they required further information regarding catheter care instructions and interventions. Audits were completed for clinical areas such as wounds and weight loss to identify any deterioration and/or improvements in people’s conditions and care was planned accordingly in response. Although physical conditions were routinely monitored, monitoring of people’s mental state could be improved by completing an analysis of incidents of distress.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Despite having decision-specific mental capacity assessments (MCAs) in place, they were poorly completed. MCAs contained inaccurate information, lacked person-centred detail, and did not demonstrate how staff had supported people to understand decisions, and exercise their rights under the Mental Capacity Act 2005 (MCA), or participate in decision-making. For example, one MCA incorrectly referred to support from a person's "son and daughter", although they had no children. Another included blanket statements and failed to consider the person's individual strengths and communication needs. Although the person's communication plan contained detailed guidance, the assessment did not evidence that staff had followed it when completing the MCA. MCAs also included information unrelated to the specific decision being considered, such as references to finances within a medicine related assessment. We were not assured that staff held meaningful, decision-specific discussions about capacity and consent. While the provider had developed communication flashcards to support people during capacity assessments, staff had not used them in any of the records reviewed. Following our feedback, leaders submitted evidence they were updating MCAs.

Care plans outlined whether people had capacity to consent in different areas of their care and included guidance around seeking consent. Staff demonstrated a good understanding of the importance of seeking consent prior to delivering care and how to empower people to exercise choice and control in decision making. A staff member said, “For people with capacity, we ask questions, stay at eye level, use simple words and pictures if they do not understand. With personal care, sometimes people will say no, we acknowledge and allow that”. Despite staff appearing knowledgeable, there were gaps in training which meant that not all staff had received training in the topic of mental capacity and Deprivation of Liberty Safeguards (DOLS).

Oversight of the quality of MCAs was not effective. Although an external audit had highlighted MCAs needed to improve, the provider had failed to update them for everyone in the home and there was no clear timescale outlined for achieving this.