Archived: Longworth House

Updated 28 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 08 and 10 May 2018. The first day was unannounced.

The inspection team consisted of one adult social care inspector.

Before our inspection visit we reviewed the information we held on Longworth House.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. This provided us with information and numerical data about the operation of the service.

Before the inspection, we were aware that the registered provider had not submitted statutory notifications about incidents and events that had occurred at the service. A notification is information about important events, which the provider is required to send us by law. We contacted health and social care professionals who worked alongside the service for information. We also reviewed the information we held about the service and the provider. We spoke to community health care workers.

We spoke with a range of people about the home including five people who lived at the home, two visitors and four care staff. In addition, we also spoke with the registered manager who is also the owner. We were unable to speak to some of the people in the home due to their communication needs.

We looked at the care records of seven people who lived at the home, staff training records, three recruitment records of staff members and records relating to the management of the service. We observed the environment and people’s interactions with staff.

Updated 28 June 2018

This unannounced inspection took place on 08 and 10 May 2018.

Longworth House 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. Both were looked at during this inspection. The care home accommodates 28 people. At the time of the inspection, there were 18 people who received support with personal care as nursing care is not provided at this home.

The service was managed by a registered manager who is also one of the service providers. 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.

At the last inspection in January 2016, the service was rated ‘Good’.

At this inspection we found that the quality and safety of the service had deteriorated. We found shortfalls in relation to the management of risks associated to receiving care. This was because staff had not always sought medical advice when people had suffered falls and had failed to report serious injuries to safeguarding authorities; people’s medicines were not safely managed and people had not been adequately supported to manage risks associated with unintentional weight loss and risks associated with choking. We also found consent to receive care had not been sought and Deprivation of Liberties authorisations had not been sought where people’s care involved restrictions to their movement. There were shortfalls in training provided at the service. The quality assurance systems were not effective in identifying shortfalls or areas where the service was not meeting regulations and driving improvements. There was also a failure to notify the Care Quality Commission of serious incidents in the service.

We found there were seven breaches of the Regulations. These were breaches of Regulations 9, 11, 12, 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of Care Quality Commission (Registration) Regulations 2009. You can see what action we told the registered provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The systems and processes for monitoring and assessing quality in the home to ensure people's safety and compliance with regulations were inadequate. There were no formal medicine audits and care plan audits. Internal audit and quality assurance systems had not been effectively implemented to assess and improve the quality of the service and to proactively identify areas of improvement. Policies in the home were outdated and not in line with current legislation, best practice and national guidance. There was a lack of managerial oversight on staff and the care that people received.

We found significant concerns with the care that people received after suffering head injuries and there was a significant number of unwitnessed falls and falls from bed. Risk assessments had not been effectively developed to minimise the potential risk of harm to people who lived at the home. They were not reviewed in line with people’s changing needs. In addition there was a lack of appropriate risk assessments and risk management processes relating to the people who are at risk of falling, choking, risks related to unintentional weight loss and risks of scalding from hot water. There were no call bells for people to use if they needed to summon for help in the communal areas. There was no falls policy or written guidance to guide staff on the management of falls.

Staff had received safeguarding training however, local authority and national safeguarding reporting guidelines had not been followed. Significant incidents had not been reported to the local authority and the Care Quality Commission. Accident and incidents had been recorded. However, on a significant number of occasions, staff had not sought medical advice where this was required. We found this to be the case especially with incidents involving unwitnessed falls which involved head injuries. Improvements were required to demonstrate what support people had received following incidents such as repeated falls.

Although some of the staff had been trained in the safe management of medicines, people had not always received their medicines as prescribed. There were shortfalls in medicine management practices in the home.

People’s consent to various aspects of their care was not always considered and where required Deprivation of Liberty Safeguards (DoLS) authorisations had not been sought from the local authority. People’s capacity to make their own decisions was not assessed.

Recruitment checks were carried out to ensure suitable people were employed to work at the home.

Care plans were in place detailing how people wished to be supported. People and their relatives were involved in care planning. However, this had not always been recorded. People’s independence was promoted.

Feedback from people and their relatives regarding the care quality was positive. People who lived at the home told us that they felt safe. Visitors and people who lived at the home spoke highly of the registered manager and the owner who is also the provider.

Risks of the spread of infections were not adequately managed. Risk associated with fire had been managed and fire prevention equipment serviced in line with related regulations. However, some doors were wedged open which could expose people to risk in the event of a fire.

The environment was clean. However, adaptations and decorations had not been adequately adapted to suit the needs of people living with dementia.

The provider had sought people’s opinions on the quality of care provided.

We observed snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments from people who lived at the home were all positive about the quality of meals provided. However, we found people were not adequately supported to manage the risk of unintentional weight loss.

We observed people being encouraged to participate in activities of their choice. People who lived at Longworth House and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

Staff had received induction and training. There was a policy on staff supervision and appraisals and staff had received regular supervision. However, systems for recording supervision required improvements and some training that we deemed necessary to ensure safe care for people living at Longworth House had not been provided.

Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home.