Longhill House Care Home

Longhill House Care Home is a residential care home providing personal care to up to 41 people. The service provides support to older people some of whom may be living with dementia, people with mental health needs, people with a physical disability and younger adults. At the time of our inspection there were 39 people using the service. Accommodation is provided in one adapted building across 2 floors and has a mixture of smaller and larger communal areas for people to use.

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

Medicines were not always managed safely. Discrepancies in stocks of medicines had been identified meaning some people had not received their medication as prescribed.

Governance systems were not always reliable or effective and actions from audits were not always followed.

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.

There were effective safeguarding systems in place and safeguarding concerns were managed promptly. Staff understood their responsibilities in relation to safeguarding and felt comfortable to raise concerns.

Risk assessments were person centred and contained enough information to guide staff in their practice.

There were enough competent, trained staff to meet people’s needs. Recruitment checks were robust.

Infection, prevention, and control was managed well, and the cleanliness of the home was of a high standard. People had access to outside space.

The provider worked collaboratively across services to understand and meet people’s needs, and people experienced positive outcomes regarding their health and well-being.

The service had a positive culture that was person-centred and empowering. People, their relatives and staff spoke positively about the registered manager and felt involved with 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 and update

The last rating for this service was requires improvement (published 25 November 2020) 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 the provider remained in breach of regulations and the service remains rated requires improvement. The service has been rated requires improvement for the last 2 consecutive inspections.

We also made a recommendation the provider seek advice and guidance regarding the Mental Capacity Act (2005). At this inspection the provider had acted on our recommendations and had made improvements.

Why we inspected

We carried out an unannounced inspection of this service on 29 September and the 1 October 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance processes.

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 undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to the safe administration of medicines and good governance.

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.

Longhill House Care Home is a care home which is registered to provide accommodation and personal care to 41 older people, some of whom may be living with dementia. At the time of our inspection, 37 people lived at the service. Accommodation is provided on one adapted building and has a mixture of smaller and larger communal areas for people to use.

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

People were at risk of their human rights being breached as one person was subject to a high level of restriction for a short time. The provider’s governance systems had not identified shortfalls with capacity assessment and best interest decision records which had contributed to the restriction. People were mostly 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. However, the policies and systems in the service did not support this practice. We have made a recommendation about mental capacity assessments and recording decisions.

Processes were in place for reporting safeguarding concerns, though on one occasion this was not done promptly. Accidents and incidents were monitored and investigated, though records did not always evidence what was learnt. Governance systems had failed to identify the shortfalls we found, which placed people at risk or receiving a poor-quality service.

People’s medicines were administered safely, and care plans contained appropriate guidance. The service was clean and appropriate processes were in place to prevent the spread of infections.

The provider’s recruitment processes helped ensure only suitable staff were employed. Staffing levels were safe. Staff were patient and supported people with their individual routines.

Staff had the relevant skills and knowledge to support people. People were offered a healthy, varied diet which met people’s preferences and dietary requirements. Staff supported people to access healthcare services and followed professional advice.

People were included in the development of the service and the provider was improving the environment. The management team supported staff and worked closely with relevant professionals.

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

Rating at last inspection

The last rating for this service was good (published 22 November 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received in relation to the Mental Capacity Act 2005 and restrictions on people’s liberty. A decision was made for us to inspect and examine those risks.

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.

We inspected and found there was a concern with safeguarding and governance systems, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Effective and Well-led. 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 have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to record keeping and addressing quality shortfalls at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Longhill House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Longhill House Care Home accommodates 41 people on two floors in one adapted building. It provides a service to older people and those who may be living with dementia. At the time of this inspection there were 39 people using the service.

The provider is required to have a registered manager in post. At this inspection there was a manager that had been registered and in post for the past year. A registered manager is a person who has registered with the 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 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 these matters. Risks were also managed and reduced so that people avoided 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 accurately reflected the staff that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication and risk of infection were safely carried out. The staff learned from accidents and incidents to avoid these being repeated.

People were cared for and supported by qualified staff that were regularly supervised and appraised regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Employees of the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager explained how the service worked with other health and social care professionals and family members to ensure decisions were made in people’s best interests where they lacked capacity. People received adequate nutrition and hydration to maintain their health and wellbeing. The premises were suitable for providing care to older people and those living with dementia.

We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook care and support tasks. People’s wellbeing, privacy, dignity and independence were monitored and respected.

People were supported according to person-centred care plans, which reflected their needs well. These were regularly reviewed. People had the opportunity to engage in pastimes and activities if they wished to in order maintain mobility and conversation skills. Activities stimulated the brain and kept people’s skills going. People had very good family connections and support networks. An effective complaint procedure was in place and people’s complaints were investigated without bias. People that used the service, relatives and their friends were encouraged to maintain relationships with one another through frequent visits, telephone calls and sharing news.

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

People had opportunities to make their views known through direct discussion with the provider’s nominated individual or the staff and management team. People were assured that recording systems used in the service protected their privacy and confidentiality of information, as records were well maintained and held securely in the premises.