Archived: Longbridge Deverill House and Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 8 quality statements in this key question.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives said they were informed quickly if there was an incident or accident. One relative said, “They [staff] are responsive in a personal way. There is lots of communication with me either by phone, e-mail or face to face. For example, when [incident] happened, within 15 minutes they'd let me know about it.” Another person’s relative said, “There was an incident previously, and the care home did do an investigation on that to see what went wrong.”

Staff told us learning from incidents was shared with them to reduce the risk of recurrence. For example, one staff member said, “It is written on the handover sheet which we are given, plus I sit in on handover and I check the care plans. If someone had a fall two days ago, that would still get handed over just so that all staff are made aware. We are then told what to do to prevent it happening again.” Another staff member said, “[Registered manager] will always ask for our input if things go wrong. [Registered manager] will often say, "why do you think it happened, what could we have done differently?"

Incidents and accidents were reported. Staff documented any injuries sustained on body maps. Incidents were investigated and when necessary, care plans were updated to reflect any change in guidance for staff. For example, falls prevention plans had been updated when people had fallen, people had been referred to the falls clinic and the service had assessed the need to use technology to provide additional oversight.

People were supported to move safely between services. One person’s relative said, “They [staff] are on top of what's needed. A short time ago [relative] had a chest infection and they immediately called the GP and they let me know straight away.” Another person’s relative said, “There is a good link between the residents, and the staff and it's all fed to other healthcare services.”

Staff told us they had a good relationship with the local GP practice and people were reviewed by a health professional when needed. We saw positive feedback from one healthcare professional in relation to a staff member who had supported one person to attend a hospital appointment. Staff told us they were able to join multi-disciplinary meetings when required with various healthcare professionals.

Professionals did not share any concerns about this quality statement. One professional said, “The team are very good at making contact for advice before it gets to the point of a referral. They just seem to notice when something isn’t quite right. They are proactive in that way. They are good at following my suggestions and develop care plans in line with my suggestions. I think I have a great relationship with [deputy manager]; [their] door is always open, or there is always someone senior around to talk to.”

The service used a nationally recognised tool to assess and respond when people’s condition deteriorated. This was a key element of patient safety and improving patient outcomes. Records showed people were reviewed by the health professionals when required. For example, records showed people were seen by the tissue viability nurse, community mental health teams and other professionals.

People told us they felt safe at the service and people’s relatives told us they were confident their family member was safe. Comments included, “I do feel that my relative is safe. There is nothing dangerous about the care home. I can be critical, and I would stand up and say or point things out if it was necessary, but I can't really criticise [the service]” and “I leave there every day in the knowledge that my relative is safe and well cared for.”

Staff had been trained and understood their responsibilities to keep people safe from avoidable harm and abuse. Staff comments included, “If one resident hit another, I would ring the bell, de-escalate the situation, document it, and write the incident form. We need to record all safeguarding incidents, to monitor for repeated behaviour, identify triggers and prevent it happening again.”

We observed staff had support from management when needed to make sure people were safe.

Safeguarding notifications to Care Quality Commission (CQC) had been made in line with requirements. The service applied for Deprivation of Liberty Safeguards (DoLS) authorisations when required. The deputy manager showed us how they monitored the status of applications. The deputy manager said, “We’ve done a lot of mental capacity and DoLS training. The staff now update me when a new restriction is put in place, such as a sensor mat or room sensor, so that I can update the DoLS applications.” When authorisations had been approved, care plans were in place. When conditions of authorisations were in place, these were being met.

People did not share any concerns about this quality statement. Relatives of people we spoke with said, “[Person] tends to stay in the bedroom. They are [staff] always checking in on [person]” and “[Person] does not have any skin sores. [They] have a special mattress that they use to help prevent skin sores.” People’s relatives told us staff invited them to review care plans. One person’s relative said, “We tend to talk through the care plan on the phone. Any changes they will introduce with ‘we've noticed’, ‘we propose’ or ‘what do you think?’ So everything is done in consultation. The care plan is a live document and is adapted as and when it's necessary.”

Staff told us they understood the importance of following care plan guidance to reduce the risk of choking. One staff member said, “I’ve done my training. I know to sit people upright, check the level of food and fluids people should have. We get taught how to [support people with meals], such as not too many distractions, use small spoons. It’s all written in the handover notes and the care notes.” Staff told us about strategies they used to support people who were experiencing distress. One staff member said, “If I learn about people's triggers and de-escalation techniques, I report it to the unit lead. Personal care is a trigger for a lot of people, so we might try other faces to support people.”

Not all air mattresses we looked at were set correctly. Air mattress check charts were in place but did not always reflect the actual setting we saw. We discussed this with the deputy manager and the registered manager informed us after the inspection that they were reviewing the check process with staff. We also observed 2 occasions where staff did not follow people’s risk management plans. We observed 1 person eating by themselves unsupervised when the care plan instructed staff to monitor closely. We saw another person being supported to eat using a dessert spoon despite the care plan instructing staff to use a teaspoon. We fed this back to the deputy manager who told us they would address this with staff involved.

People had been assessed for risks such as falls, skin breakdown, choking and malnutrition. Risk assessments had been reviewed regularly. When risks had been identified, care plans provided guidance for staff on how to reduce the risk of harm to people. For example, when people were at risk of skin breakdown, care plans included information about any pressure relieving equipment in use and how often staff should support people to change position. Position change records showed people had their positions changed in line with care plan guidance. Some people experienced periods when they were upset or agitated. Care plans for people described any known triggers and the steps staff should take to support people and keep them safe. Some people had been assessed as being at risk of choking. Care plans provided instructions for staff on any textured diets and thickened fluids that were needed, as well as details of any specific cutlery to be used and the position people should be in when being supported with food or drink to reduce the risk of choking. Wound plans we looked at informed staff of wound dressings in use and how often wounds should be reviewed.

People using the service told us they felt safe and did not share any concerns about this quality statement.

Staff comments included, “There is a big refurb happening, we're hoping to get all new furniture” and, “If I could change anything it would be the carpets on [unit name].” The deputy manager told us they regularly walked around the building to check for safety and see people and the staff.

We observed management walking around the home to carry out safety checks. We also observed maintenance workers were on hand to make any repairs and check the premises for safety. Equipment that we looked at was fit for purpose.

We reviewed records of checks carried out to ensure the premises were safe. These included gas, electrical and fire safety checks. Regular checks of equipment were carried out. All windows had restrictors in place. Personal emergency evacuation plans were in place. We saw these had recently been reviewed to reflect people’s support needs in the event of needing to evacuate the building in the event of an emergency.

People we spoke with who used the service told us they felt there were not always enough staff on duty. One person said, “Staff are all busy here; I’m pretty lucky that I don’t need help.” People told us staff did not always respond when they rang their call bell. Comments included, “It’s so short of staff here it’s unbelievable. You can’t expect them to come quickly” and, “Sometimes it takes a long time for them [staff] to come if you want them.” We had mixed feedback from people’s relatives. Positive comments included, “They seem to have enough staff and the weekends are the same as the weekdays” and, “They have stopped using agency staff and for continuity of care from my relative’s perspective it's made a huge positive difference.” Other people’s relatives said, “I do think that they are a bit short staffed” and, “I'm not sure whether they have enough staff. When they had empty rooms it wasn't so bad, but they are full now and for example there were only two carers on duty today for about 15 or 16 residents.”

Staff gave mixed feedback about staffing levels. Some staff felt the number of them on duty was enough, while others disagreed. Comments included, “We could do with another pair of hands. When you cut down on quantity you cut down on quality. People’s physical needs are met, but sometimes it’s the emotional support we can't provide” and, “It can be difficult with staffing. There are only two of us and this can be challenging. If we are both in a room with someone, another staff member comes to observe the unit.” Other staff said, “We manage well with what we've got. We all have radios, so we all help out, and the activities staff will support if needed” and, “Yes, we have enough staff.” Staff told us they felt supported in their roles and had regular supervision sessions with a line manager or supervisor.

Staff were not always visible around the building, but when we did see them they did not appear rushed, and we saw staff take their time when supporting people. Call bells were generally answered in a timely manner.

The service used a dependency tool to calculate staffing levels based on people’s care and support needs. The staff rota showed that staffing levels were maintained. Safe recruitment processes were followed and staff had the training they needed. There were regular staff meetings and staff had supervision to discuss any training needs.

People and their relatives gave mixed feedback about the cleanliness of the service. People living at the service raised no concerns. Comments included, “Yes. Very good cleaners here” and, “Very clean, they keep it very clean.” Some relatives said, “The building is well designed and clean” and “The building is constantly being cleaned and the cleaners seem like part of the family.” Other people’s relatives said, “The rooms are clean but there are odd areas for example in the sitting room the floor is not great. The edges of the paintwork are not great, and the place could do with being re decorated” and, “One disappointing thing is the smell on [person’s] floor. They [staff] changed the carpet around Christmas time and put some hard flooring in, so the smell went but it seems to have come back, and I don't know why.”

We discussed our observations of shortfalls in the environment with the area director and deputy manager who advised us that decorating was part of the provider’s current refurbishment plan. We were informed after the inspection that new furniture had been ordered and that a new carpet had been ordered.

The environment in some areas was tired and worn and did not always promote an appealing place to be. Some carpets were worn and visibly dirty and some armchairs were stained. There were cobwebs on some of the light fittings. The wood flooring join to the carpet was missing in one of the lounge areas, and the strip was visible and porous. Chipped and worn fixtures and fittings meant it would not always be easy to prevent cross contamination.

Infection prevention control audits had been carried out. We reviewed the latest audit which showed the provider had noted areas of concern around furniture and fittings. Whilst the shortfalls had been identified, action had not been taken to make the improvement needed until our assessment. Housekeeping staff were on duty seven days a week. Cleaning chemicals were safely locked away when not in use by staff. Staff had been trained in infection prevention and control and knew when and how to apply personal protective equipment (PPE) and when and how to safely discard it after use. There was enough PPE available for staff to use.

People’s relatives told us they were informed about medicine reviews. One person’s relative said, “I have a high level of trust with them in dealing with the medication and doing the right thing to support [person]. It's always a bit of a balancing act between medicating [person] so that [person] is not agitated and not over medicating [them] so that [they] have more falls.”

The deputy manager told us regular medicine reviews were carried out. Records showed people who were prescribed anti-psychotic medicines had their medicines regularly reviewed. We saw the deputy manager maintained oversight of this. Staff told us they had been provided with medicines training and had their competence assessed to administer medicines. Medicine incidents and errors were reported and investigated and the deputy manager told us any lessons learned were shared with staff.

In the main, medicines were managed safely. Manufacturer advice regarding placement of transdermal medicine patches was not being followed. These patches should not be placed on the same area of skin for at least 3 to 4 weeks, but records showed they were often rotated weekly between two sites. We discussed this with the nurses and by day 2 of the assessment a revised patch record form had been implemented. The service used homely remedies alongside prescribed medicines. Homely remedies are medicines that can be bought over the counter for occasional use. Although records were in place to monitor stock balances, we identified a discrepancy between what was recorded and what was in stock. The management team investigated and resolved the issue by day 2 of this assessment. Medicines were stored safely. Temperatures of storage areas including medicine fridges was monitored. Medicine administration records were all signed to indicate people had received their medicines as prescribed. Some people had been prescribed additional medicines on an as required basis (PRN). In these cases, PRN protocols were in place and were person-centred and detailed when and why people might need additional medicine.