Archived: Longworth House

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.

Longworth House is registered to provide personal care for up to 28 older people. The home is situated in a rural location in Higher Ramsgreave, Blackburn. There are three lounge areas and a passenger lift to the upper floor. All rooms have an emergency call system. At the time of inspection there were 25 people accommodated in the home.

We last inspected the home on 29 and 30 July 2014 and found the service was not meeting one of the regulations that was applicable at that time in relation to records. We carried out a follow up visit on the 24 September and found improvements had been made. During this inspection we found the service was meeting the current regulations.

The service was managed by 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.

People living in the home told us they felt safe and well cared for. They considered there was enough staff to support them when they needed any help. The registered manager followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively.

The staff we spoke with were knowledgeable about the individual needs of the people and knew how to recognise signs of abuse. Arrangements were in place to make sure staff were trained and supervised at all times.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained to do this safely.

Risks to people’s health and safety had been identified, assessed and managed safely.

We found the premises to be clean and hygienic and appropriately maintained. Regular health and safety checks were carried out and equipment used was appropriately maintained. The service held a maximum five star rating award for food hygiene from Environmental Health.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

People told us they had their privacy respected by all staff. Each person had an individual care plan that was sufficiently detailed to ensure people were at the centre of their care. Care files contained a profile of people’s needs that set out what was important to each person, for example how they were dressed, personal care and how they could best be supported.

People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. Staff had been trained in End of Life care. This meant staff could approach people’s end of life care with confidence and ensure their dignity, comfort and respect was considered.

Activities were varied and visiting arrangements were good.

People were provided with a nutritionally balanced diet. All of the people we spoke with said that the food served in the home was very good.

People told us they were confident to raise any issue of concern with the provider and staff and that it would be taken seriously. They were regularly encouraged to express their views and opinions and also had opportunities to give feedback about the service, the staff and their environment in quality assurance surveys.

All people, their relatives and staff spoken with said the management of the service was very good and they had confidence in the registered manager. There were systems in place to monitor the quality of the service and evidence to show improvements were made as a result of this.

We found significant improvement in how records were being maintained. This helped to make sure people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were being maintained.

We were satisfied the service was fully meeting the requirements of this outcome.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with eight people using the service, looked at care records of three people in detail and a selection of other records in relation to other people's care. We also spoke to four care staff, the cook, and the registered manager.

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home they had an assessment carried out to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

The manager understood their obligation to apply the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

People told us they were treated very well by the staff. Each person had an individual care plan which was linked to risk assessments. Risk assessments identified and informed staff who may be at risk of falling, developing pressure ulcers or may not eat enough. Better record keeping was required to ensure nutritional risk assessments were based on accurate information.

Good recruitment practices were followed in making sure people were protected and kept safe by employing people who had proven good character records. There was a good skill mix of staff deployed on each shift, taking into consideration people's qualifications, skills and experiences. This meant people were cared for by staff able to care for them properly and safely.

People told us they were confident to raise any issue of concern they may have. One person told us, 'You can definitely say if something isn't right, it will be sorted.' A system was in place for receiving compliments and complaints. People we spoke with told us they would know how to make a complaint, should they need to do so.

Staff were trained in emergency procedures such as fire and first aid. All staff had been trained in the safe moving and handling of people. Staff used safe ways of working, for example, when they used a hoist to assist them in moving people.

Guidance was being followed such as health and safety in the work place, infection control, fire regulations and control of hazardous substances. This reduced the risks to people. There were arrangements in place for the safe removal of clinical and sanitary waste. Routine control measures for Legionella had been completed and water systems were certified as being safe.

Is the service caring?

People told us they were happy with the care they received and the staff team. Staff were described as very good and nice. Comments included, 'All the staff are very helpful and we can have a laugh and a joke with them. They have time to have a chat with me.' 'I get all the help I need. I haven't been here very long. I can do a lot of things myself but when I struggle, the staff are there straight away. I only have to ring my buzzer. It doesn't matter what time it is. And yes, I'm very happy thank you.' 'I can't grumble. The service is very good. I like being in my room, it's nice sometimes to be on your own.'

Daily records maintained showed staff responded to people's needs as required day and night. Staff gave a good account of, and showed an understanding of, the varying needs of different people we had discussed with them.

People were able to make choices regarding their lifestyle. They had the opportunity and scope to express their wishes for daily living and social activity, and this was respected. This supported people to be cared for in a way that did not inappropriately restrict their freedom.

Is the service responsive?

People were given plenty of opportunities to say what they wanted. People's assessment of needs and care plans were reviewed regularly and professional help and support was sought from other health and social care professionals when needed.

Good practice was followed to make sure people were admitted properly. People had the opportunity to bring personal items of furniture that could be reasonable accommodated. A continuing assessment of need was on-going for people, including mental capacity assessments to support continuing care needs being addressed appropriately.

Staff had relevant training to support them in their role and to deal with emergencies such as fire and first aid. Arrangements were in place to deal with emergency situations such as fire evacuation although people did not have a personal evacuation plan to assist emergency services support the most vulnerable people. .

People using the service and their relatives had the opportunity to complete a satisfaction survey. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Residents meetings were being held and people were able to give their views on the service they received. We saw that there was continuing investment being made with the environment and with providing the equipment staff needed to support people.

Is the service effective?

People told us they were happy with their care. They had their own preferred routines, likes and dislikes. There were no unnecessary rules to follow and no rigid routines. People said staff were 'good' and 'helpful'. One person told us, 'They are all very good and willing to help when they can. I'm unsteady on my feet so they walk alongside me and they make sure I'm settled in my chair.' People had also commented in a survey carried out, 'I like to lie in bed until 8am and I go to bed when I'm ready'. 'I like to have breakfast in my room'. And 'I like to stay in bed longer and keep my legs elevated'. A relative wrote, 'When we asked if he was happy he always said, I have a comfy bed. The food is good, the staff are very kind-what more could you want for a reference'.

People's health and well-being was monitored. Appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Staff considered they had time to spend with people. They told us team work was very good, and they had good training. We saw there was sufficient staff on each shift with a range of skills and experience. This meant people were being cared for by a staff team with the knowledge to meet their needs.

Is the service well led?

Staff told us they were supported to develop their skills and given opportunity to attend training.

Staff were clear about their responsibilities and duty of care and were able to raise their views and discuss work issues at staff meetings and in one to one supervision. The registered manager was on the premises most days and on call in the evenings.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. Improvement was needed in how this was managed by maintaining good records that were accurate and provided essential information for monitoring purposes. We saw evidence the service knew when to consult with health and social care professionals when required. This meant any decision about people's care and support was made by the appropriate staff at the appropriate level.

We found people living in the home received care that maintained their privacy and dignity and upheld their independence. We found people were able to make choices about their daily lives and the care they received.

We reviewed the care files of two people who lived in the home. We saw that care plans identified their needs and how to prevent of any risks identified. Records we looked at included information on how they wished their care to be delivered and what their likes dislikes and preferences were. We found the care plans were reviewed monthly.

We found policies and procedures needed to be reviewed and in particular the safeguarding policy to reflect local and national guidance. We found updated safeguarding training had been organised for all staff to attend in October 2013.

We found there were sufficient staff on duty during our visit and a weekly rota was in place. We also found the manager and staff were available to cover any unexpected sickness, vacancies and emergencies.

We found that some systems were in place to assess and monitor the quality of the service provided.

Most people spoken with told us they were happy with the care provided. One person told us they were, 'Looked after as well as we could be' and said they 'were happy living at the home". People's needs were assessed and care plans were personalised and reviewed regularly.

Suitable arrangements were in place to co-operate with other providers of services. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

Suitable arrangements were in place to support staff who had access to ongoing training and supervision.

The home had suitable and effective arrangements in place in relation to complaints and feedback about the home.