Longwood Grange

Longwood Grange is a care home providing personal care for up to 34 people, some of whom are living with dementia. Accommodation is located on the first floor, with communal areas available on both the ground and first floor. At the time of our inspection there were 30 people using the service.

People’s experience of the service and what we found:

There were enough staff to meet people’s needs, however deployment of those staff was sometimes disorganised. Staff were recruited safely.

People had their care needs and risks assessed and they were protected from abuse and avoidable harm. Accidents and incidents were reported and managed appropriately and learning was used to improve the service. Medicines were managed safely.

Safe infection prevention and control (IPC) practices were in place. The environment was in need of refurbishment in places. The provider had a plan in place to address this.

The registered manager maintained good oversight of the service and engaged with people, relatives, staff, and external agencies. Quality assurance systems and processes were effectively used to drive service improvement. The service worked in collaboration with other health care professionals to achieve good outcomes for people.

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.

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 05 July 2019) and there were breaches of regulation. 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 improvement had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the registered manager review the relevant guidance in relation to statutory notifications. At this inspection we found statutory notifications were being submitted as required.

Why we inspected

This inspection was prompted in part by a review of the information we held. When we last inspected Longwood Grange on 28 May 2019 and 03 June 2019 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Longwood Grange on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation regarding staff deployment processes.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were secure procedures to ensure all visitors to the service helped to prevent the spread of infection, through checking proof of COVID-19 testing and vaccination, as well as ensuring hand sanitising and use of Personal Protective Equipment (PPE).

There was a newly appointed designated housekeeping manager who was responsible for ensuring infection prevention and control (IPC) procedures and standards were maintained.

There were regular cleaning regimes, although some areas of the home were more difficult to keep clean due to the need for refurbishment.

Longwood Grange provides accommodation, care and support for up to 31 people over 65 years old including people living with dementia, people receiving end of life care and people on respite care. At the time of our inspection, there were 27 people living at the service. The home is constituted by one adapted building.

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

People and relatives told us they felt safe with the care provided. One person said, “I feel safe.”

The service had improved since our last inspection however further improvements needed to continue and become further embedded into practice.

The provider continued in breach of the regulations in relation to safe care and treatment and good governance. We found inconsistency in how risks to people’s care were managed, in the level of detail in people’s risk assessments and relevant care plans and ‘as and required’ medication was not always offered when required. The provider had several systems in place to monitor the quality of the service, but these had not been effective in identifying and addressing the issues found at this inspection. Some of the issues found at this inspection had already been identified in our previous inspection. We have made a recommendation about notifying CQC about safeguarding concerns.

We received mixed views about the quality and frequency of the activities happening at the home. There was a regular programme of activities. However, we continued to see people were not offered enough social stimulation throughout the day and spend long periods of time sitting in the lounge.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in their care plans.

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

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests. However, improvements were required in recording consent for people who lacked capacity to make decisions.

People were supported by staff who were motivated, enjoyed their job and felt well supported through regular supervisions and training.

Feedback from people, relatives and staff was positive and they felt the service was well-led. They told us the management team were always available to speak with and were approachable. The registered manager was responsive in addressing the issues found at this inspection. They had developed several links with the community to support care provision.

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 30 November 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 enough improvement had not been sustained and the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

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

Longwood Grange is a care home for up to 34 people. At the time of this inspection there were 29 people living at the home (30 on second day). People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Longwood Grange consists of one building with two floors; communal areas are located in the first floor and bedrooms on the second floor.

Longwood Grange was last inspected on the 21 and 22 December 2016. At that time it was rated requires improvement overall and was in breach of regulations in relation to consent, safe care and treatment, staff’s access to training and supervision, fit and proper people employed and good governance. This was the third time this service was rated required improvement. Following the last inspection, we have served a warning notice on the registered provider and told they had to become compliant with the Regulations by 12 April 2018. At this inspection we found not enough improvements had been made in some of the areas identified and the provider was in continuous breach of regulations related with consent, safe care and treatment, fit and proper people employed and good governance. We also identified two new breaches in relation to person centred care and dignity and respect.

At the time of this inspection the service had a home manager since June 2018 who had not registered to manage the service. The home manager was on annual leave during our inspection visits but the deputy manager and regional support manager were available to provide information. After our visits, we spoke with the home manager to gather more information in relation to some areas of concern. It is a legal requirement that the home has a registered manager in post. 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.

We found widespread failings in the oversight, monitoring and management of the service, which meant people did not always receive safe care.

The provider’s compliance with the Mental Capacity Act 2005 was inconsistent. Assessments and best interest decisions for some people living with dementia were in place but we saw relatives giving consent for decisions without having lasting power of attorney. There was no evidence people were being restricted or receiving care that was not in their best interests.

Medicines were not always administered in a safe way. We found medicines were given in a caring way however we could not be certain these were always administered as prescribed and there were no protocols for people who required ‘as and when required’ medication.

Risks to people were not always managed safely. The provider was not checking the temperature of the water before helping people to take a shower or bath therefore putting them at the risk of being scalded. Not all staff had been involved in a fire drill, in particular night staff, so the provider could not evidence staff would be able to safely evacuate people in an event of a fire. Other risks related with people’s care such as their skin integrity, mobility, eating and drinking were being identified, assessed and managed.

The provider was not consistently recording the accidents and incidents that happened at the home or analysing any patterns and trends to prevent them happening again.

We received variable feedback from people, relatives and staff about staffing levels at the home. The home used a dependency tool to assess people’s needs and determine staffing levels however our analysis of the rotas did not evidence there were always the required members of staff on shift.

Staff did not always complete relevant training for their roles. Staff had access to regular supervision since new home manager had been appointed but this was not consistently happening before.

People’s privacy and confidentiality wasn’t always maintained. We saw people’s records weren’t safely stored and we observed staff talking about people’s confidential matters in communal areas.

Recruitment process were not robust. Staff’s full employment history and appropriate references were not always sought in line with regulations.

We received variable feedback from people in relation to the quality of the meals and meal experience. Care and catering staff were well-informed about people's dietary needs, food preferences and dislikes. People at risk of losing weight were monitored and when required referred to other healthcare professionals, however records of people’s food intake lacked detail and this did not allow the provider to have an accurate picture of what people were eating and what time.

People did not always receive person-centred care. We found one person who displayed behaviour that challenged and others did not a behaviour support plan and advice from mental health professionals was not being followed. Another person at risk of choking did not have an eating and drinking care plan.

There was a regular and varied programme of activities at the home and most people spoke positively about the activities coordinators however we found people were not offered enough social stimulation throughout the day and spend long periods of time sitting in the lounge.

We saw examples of people being treated in a caring way by staff.

Staff told us that they felt supported by the staff team. Where appropriate notifications were sent to the CQC.

There were several systems in place to monitor the quality of care however these were not effective in identifying the issues found at this inspection. The provider had improvement plans in place and told us they had completed these however our findings at this inspection did not evidence this. The governance systems in place were not effective in implementing the necessary changes and improvements already identified at previous inspections.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Where regulations have been breached information regarding these breaches is at the back of this report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is complete. Where providers are not meeting the fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service.

When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

Longwood Grange was last inspected in November 2015. At that time it was rated as ‘requires improvement’ in all aspects except Caring, which it was rated as ‘good.’

At the time of this inspection, 30 people were living at the home; one of these people was there for respite care.

The home did not have a registered manager. The last registered manager left in June 2016. A new home manager had started work at the home two days before this inspection. Their intention was to apply to be the registered manager. 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.

We found some aspects of the recruitment process for new staff could not be evidenced by the home.

Risk assessments and care plans did not always contain the level of detail staff needed to support people to move safely. This was also found at our last inspection in November 2015.

We found personal emergency evacuation plans or PEEPs did not contain the level of detail required for staff to support people to evacuate in an emergency. This was identified at our last inspection in November 2015. There had been no fire drills at the home in 2016 and less than half the staff had up to date fire safety training.

Care workers had not always received the training, supervision and appraisal they needed to support people effectively. Issues with access to supervision were noted at our last inspection in November 2015.

People who needed to be deprived of their liberty to keep them safe had the correct authorisations in place. Most mental capacity assessments and best interest decision documentation we saw was not correct. Some people’s care files showed family members had made decisions on their behalf when there was no evidence they had the appropriate powers of attorney.

People told us they enjoyed the food and drinks served in the home. We observed people had access to drinks and snacks, and were provided with choices. Records showed one person was not supported according to a dietician’s advice. People’s food and fluid intake records were not sufficiently detailed to make them useful.

The home could not evidence it had fully investigated and responded to a formal complaint received from a person’s relative in 2016.

By comparing accidents and incidents at the home with notifications made to CQC, we found three instances of physical abuse or threats of physical abuse involving people at the home had not been reported as is required.

A lack of consistent management and leadership at the home in 2016 meant there had been issues with record-keeping, staff access to supervision and the quality of audit.

At the time of this inspection ratings from the last inspection in November 2015 were prominently displayed in the home, but not on the home’s website, as is required by the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2015. We notified the registered provider who told us it had been an oversight when the website had been updated. We saw the ratings were reinstated on the website immediately.

Oral medicines, including controlled drugs, were administered and managed safely. Records for the administration of topical creams and lotions kept in people’s rooms were incomplete.

Accidents and incidents had been investigated, although we identified gaps in documentation and times when interim managers had lacked oversight of incident records.

People and their relatives told us there were enough staff to support people safely and our observations supported this. Some care workers thought there should be more staff in the afternoons and evenings.

People’s care plans were detailed and person-centred, but they were not always updated when changes in people’s circumstances occurred. Daily records could not always evidence people were supported according to their care plans.

People, their relatives and staff had been given opportunities to feedback about the home, although general meetings with management had not been held on a regular basis. Senior staff representing each aspect of the home met briefly most days to share information.

People told us they felt safe. Care workers could describe the different forms of abuse and said they would report any concerns appropriately.

Checks had been made to ensure the building, its utilities and facilities were safe. Comprehensive records to evidence the checks could not be located during the inspection, but were provided shortly afterwards.

People and their relatives thought the home was clean and tidy. We found the home to be clean and odour-free.

People told us they had access to healthcare professionals, such as GPs and community nurses, and their relatives agreed. Care files we saw supported this.

People told us staff at the home were caring and respected their dignity and privacy. We saw staff knew the people well as individuals. The home had a happy and vibrant atmosphere.

People were asked for consent by staff before support was provided. People could decide when to get up, where to spend their day and when they wanted to shower or bathe. People who struggled to make decisions had access to advocacy services.

People and their relatives were involved in planning people’s care and support.

The home worked with GPs and community nurses to provide end of life care to people whose needs could be met in a residential care setting. The new home manager planned to request specialist end of life care training for care workers in 2017.

People told us they were happy with the amount and type of activities on offer at the home. We observed people enjoying activities during the inspection and records showed people regularly took part in activities.

Care staff told us they enjoyed working at the home and supporting the people who lived there.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 and Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.

Longwood Grange is a registered care home situation in the village of Longwood, outside Huddersfield. It provides accommodation and personal care for up to 34 people. At the time of our inspection there were 24 people living there. Four people were living with dementia. The home 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.

We found staffing levels at the service had improved since our last inspection. People told us their call bells were answered in a timely manner and staff responded to their needs.

Staff had received training in safeguarding people from abuse and were able to tell us what they would do if they suspected abuse was happening.

Medicines management and administration had significantly improved since our last inspection but we found an issue with medicines which had been crushed prior to administration which was not in accordance with the guidance provided by the pharmacy and was not safe practice. This was addressed immediately by the registered manager who ordered liquid medicine.

Staff had received regular training to ensure they had the skills to perform in their role. Some staff were supported to undertake courses to attain NVQ relevant to their position.

People's nutritional and hydration needs were well met and people told us they liked the food served at Longwood Grange.

People whose liberty was deprived had been referred to the local authority for an authorisation in accordance with the Mental Capacity Act 2005. However, we found capacity assessments were general and did not always relate to the specific decision to be made. We found medicines had been administered covertly without the lawful authority to do so, on the advice of the GP. The registered manager was to initiate a best interest meeting immediately to ensure this practice was lawful.

Staff were kind, caring and compassionate to the people who lived there and the relationships between staff and the people they supported were observed to be respectful and dignified.

People's independence was actively promoted and the registered manager encouraged people to be part of the local community.

Care records had improved but there were still sections which were incomplete and daily records were repetitive and did not show the daily experience of the person living at the home.

The registered manager ensured there were very few complaints by encouraging relatives to regularly feedback verbally about the service and how they believed it could be improved.

The registered manager had improved the care provided at the home over the previous few months and was aware that improvements in management reports needed to be their next focus. Improvements in the décor and the environment had created a very homely, friendly atmosphere at Longwood Grange. The registered manager and the staff had a vision for the service which included promoting independence for the people living there but also ensuring the reputation of Longwood Grange as a respected home with a high standard of care for the people living there.

We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who lived at the home, staff members, managers and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were some systems in place to ensure managers and staff learned from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. However, we found that there were no written records of audits in the last three months.

We found many areas at the home were unclean and equipment was not always well maintained. However, the local authority infection control team had recently made a visit to the home and implemented an action plan for the home to meet and follow.

We found some issues within the sample of care records we looked at.

Is the service effective?

People's care records were written with their involvement or with the involvement of relatives and other healthcare professionals.

We found that people's care records were up to date and contained correct and accurate information.

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People's preferences, interests, aspirations and diverse needs had been recorded in care records.

Is the service responsive?

People did not partake in many activities at the home. On the day of our visit we observed people sitting in lounges with no interaction from staff members for a considerable length of time. People who lived at the home told us they would like more activities to partake in.

Is the service well-led?

The service had quality assurance systems in place and, where shortfalls were identified, actions were identified. However, we found there had been a lack of audits carried out at the home over the last 3 months. We also found many areas of the home were dirty, though this had not been identified during audits of the environment at the home. We spoke with the manager about this, who told us audits had not been carried out recently due to them being relatively new in post. The manager said they would ensure that audits were carried out regularly.

Staff told us they were clear about their roles and responsibilities. People who lived at the home and staff we spoke with said they felt care staff were 'stretched' and did not have a lot of time to carry out their duties.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who lived at the home, their relatives, staff members and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff and told us they felt safe.

Systems were in place to ensure managers and staff learned from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw staff members had received training in dementia and creating a dementia friendly environment.

The service was safe, clean and hygienic and equipment was well maintained.

The registered manager set staff rotas, taking people's care needs into account when making decisions about staff numbers. This helped ensure people's needs were able to be met.

Is the service effective?

Where possible, people's care records were assessed with their involvement and with the involvement of relatives and other healthcare professionals

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

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

Is the service responsive?

People completed a range of activities at the home. On the day of our visit we observed people watching television, singing and playing musical instruments. People who lived at the home told us they liked to do baking with the kitchen assistant.

People, or relatives of people, knew how to complain if they were unhappy. People we spoke with said the manager was approachable, including staff members. One member of staff we spoke with told us; 'It's good here. A lot of things have changed and staff morale is lots better'.

Is the service well-led?

The service worked well with other agencies and services to make sure people received the most suitable care. This included multi-agency work with the local authority and Care Quality Commission.

The service had quality assurance systems in place and, where shortfalls were identified, actions were identified. We found some issues with the completion of audits, where actions hadn't been signed off when completed. We spoke with the manager about this and they told us they would ensure that this would be put into practice.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. Staff were also aware of audits and observations carried out by the manager to monitor and improve service provision. This helped to ensure people received a good quality service.

We found some issues with staff members not recording people's personal care in care files.

We also found some issues with Disclosure and Barring Service (DBS) checks being out of date. We spoke with the manager about this. The manager told us they had been in post since October 2013 and had only just been made aware that some DBS checks were out of date. We saw evidence that the manager was taking appropriate action to remedy this issue.

We carried out this review to review evidence submitted by the home and to check whether improvements had been made.

On the day of our visit there were six people living at Longwood Grange. During our visit we spoke with the manager and five members of staff. One of the people living at the home had been admitted on the day of our inspection and the other five people living at the home had lived there for at least 12 months.

The manager explained they had taken up the position home manager on 3 June 2013, following the resignation of the previous registered manager. At the time of our inspection the new manager told us they were in the process of applying to become the registered manager.

During our visit we spoke with two care staff about safeguarding and abuse. Following our visit we spoke with a further three care staff. The care staff we spoke with told us they were pleased there was a permanent manager in post. Staff told us they did safeguarding training annually using e-learning. Three of the five staff we spoke with told us their training was currently out of date.

On the day of our visit there were five people living at Longwood Grange. During our visit we spoke with the temporary manager, two people who lived in the home, a relative and two members of staff.

The two people we spoke with told us the food was good and they always got a choice. They told us they felt safe living at the home and had never needed to make a complaint. One person said 'I have a nice bedroom and you can bring their own things'. When we asked them about the staff they told us the staff were helpful, kind, and friendly. One person said 'Its okay here and the staff are alright'. One person liked reading and told us there were always plenty of books available. They said 'I'm quite contented here'.

The relative we spoke said 'I'm always impressed; the staff are willing to go the extra mile. They are really caring and I am very happy with the care provided'.

The two staff we spoke with told us they felt confident the care provided at the home was good and that they had a good team. One of them told us 'It's a nice home in a nice area and staff know all the residents really well. Staff all care about the residents'. They told us they felt well-supported by the new temporary manager.