Archived: Longridge Care Home Limited

People’s experience of using this service:

People did not consistently receive safe care. Medicines were not managed safely. Staff were not always available to support people when they needed it. Staff were not always recruited safely and consistently trained.

People were not consistently receiving effective support. People did not always have a choice of meal. People did not consistently receive caring and responsive support. People’s individual preferences and diverse needs were not consistently considered.

The systems in place to monitor the quality of care were not effective and actions were not driving improvements. This was the sixth time the service had been inspected and had failed to achieve a good rating and people had been exposed to poor care.

People felt safe and comfortable living at the home. Risks to people’s safety were managed. People’s health needs were met and they had access to health professionals.

People were supported by caring staff. People’s privacy and dignity was maintained. People were supported to maintain their independence. Staff were responsive to people’s needs. People could make a complaint.

The service met the characteristics of Inadequate in most areas and was rated Inadequate overall.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 5 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found and appeals is added to report after any representations and appeals have been concluded.

Follow up: The overall rating for the service is inadequate and the service will be placed 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, 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. We will continue to monitor intelligence we receive about the service until we return to visit.

Longridge Care Home Limited is a care home providing accommodation and personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 32 people.

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

People did not consistently receive safe care. The identified risks to people’s safety had not been effectively mitigated. Areas of increased or new risk were not assessed and planned for. Staff were not aware of how to keep people safe and manage risks to safety. Medicines were not managed safely. People were not kept safe from incidents of abuse as incidents were not reported to allow investigation by outside bodies. There were insufficient suitably skilled and trained staff available to support people to meet their needs safely.

The provider had not acted to address the concerns identified in the last inspection. There were no plans in place to address the short falls and people remained at risk. The systems to monitor the quality of care were not effective in identifying concerns. Actions were not taken to make improvements where issues had been identified. There were failings in leadership and the provider was not ensuring people were kept safe and people continued to be exposed to poor care.

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 Inadequate (published 19 June 2019). At this focussed inspection improvements had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of risks, staffing and support with people’s medicines administration. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. Ratings from the previous comprehensive inspection for other Key Questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe 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 Longridge Care Home Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, staffing and governance at this inspection.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

Longridge Care Home Limited is a 'care home'. 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.

The care home accommodates 32 people in one building. At the time of the inspection 14 people were using the service.

There was a new manager in post who was yet to register with us. 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's medicines were not being consistently well managed and risks of harm to people were assessed however action was not always taken to reduce the risk of harm following incidents.

The principles of the Mental Capacity Act 2005 were not always followed as people who lacked capacity were not always being supported to consent to their care.

Health care advice was sought when a person became unwell, however the advice was not always followed.

The environment required some refurbishment however it had been adapted to meet people's physical needs. There were infection control procedures in place to prevent the spread of infection.

People were not always treated with dignity and respect and people' care needs and preferences required reviewing with them.

There was a new manager in post who was yet to register with us (CQC).Some of the systems in place to monitor the quality of service were yet to be effective. Action to improve had been taken, however further improvements were required.

There were sufficient staff to meet the needs of people and people were safeguarded from the risk of abuse as staff followed safeguarding procedures when they suspected abuse. New staff were employed through safe recruitment procedures.

People's needs were being assessed with them and staff liaised with other agencies to ensure a holistic approach to people's care.

Staff were receiving training and support to be able to meet people's needs effectively.

People were offered a choice of food and drink and they were encouraged to eat and drink sufficient amounts.

People were involved in planning and agreeing their care and their right to privacy was upheld.

The new manager was liked and respected by staff and the culture of the service had improved as people's choices and preferences were being gained and respected.

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, 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.

Longridge Care Home is registered to provide accommodation and personal care for up to 32 people. At the time of the inspection 19 people were using the service.

There was a registered manager in post. 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.

Risks of harm to people were not being assessed, managed or reduced to prevent further incidents which had resulted in harm.

People were not being safeguarded from the risk of abuse because the registered manager and staff did not recognise and report potential abuse.

Staff were not always safely deployed throughout the building to ensure adequate supervision and support of people was available.

People's medication was stored and administered safely, however prompt action was not taken when people refused to take their medicines.

People were not always consenting to their care and support at the service. The principles of the Mental Capacity Act 2005 (MCA 2005) were not being consistently followed to ensure that people's mental capacity was assessed and support was gained to make decisions in their best interests if they lacked capacity.

Health care advice was not always sought in a timely manner when people showed signs of becoming unwell.

Staff were not always effective in their roles as they were not receiving support and guidance they required to improve the quality of care for people.

People were not always treated with dignity and respect and their right to privacy was not encouraged and upheld.

People were not always supported to be independent as they were able to be due to routines and restrictions.

People were not all receiving care that met their assessed needs and individual preferences due to a lack of effective reviews and assessment of needs.

There was a complaints procedure, however when people raised concerns these were not acted upon. People's views were not being taken into account to ensure their experiences at the service improved.

The systems the provider had in place to monitor and improve the quality of the service remained ineffective and prompt action was not being taken to address the concerns highlighted by other agencies.

There was a culture of institutionalised care that the registered manager had failed to recognise and respond to.

Hobbies and activities were available to people who chose to join in.

People were supported to eat and drink sufficient amounts to remain healthy.

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, 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.

Longridge Care Home is registered to provide accommodation and personal care for up to 32 people. At the time of the inspection 24 people were using the service.

There was a registered manager in post. 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 were not receiving care that was safe as staff had not been trained to support people to mobilise safely. There were insufficient suitably trained staff to keep people safe.

Staff did not always follow people's individual risk assessments to reduce the risk of harm and people's prescribed external creams were not managed safely.

People were not always safeguarded from abuse as potential safeguarding incidents were not being reported to the local authority. Investigations into incidents and accidents did not always take place to prevent the incident occurring again.

People were not always treated with dignity and respect and people's right to privacy was compromised. People's right to relationships were not always respected.

People were not offered opportunities to engage in hobbies and activities of their liking and there were routines and restrictions in place which meant people did not receive personalised care.

The principles of The MCA 2005 were not being consistently followed to support people who lacked capacity to consent to their care at the service. Consent was not always gained prior to people receiving support with their daily living needs.

The systems in place to monitor and improve the quality of care were ineffective. There was a lack of clear leadership and organisation in relation to staff performance and receiving the training they required to fulfil their roles effectively. People's views on the service were not being routinely sought to ensure they were happy with their care

People received health care support and advice when they became unwell or their needs changed and they were supported to eat and drink sufficient amounts to remain healthy.

At this inspection we found that improvements had been made in most areas of concern and the provider was no longer in breach of any Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However further improvements were required.

The service provides accommodation and personal care for up to 32 people, some of whom may have dementia and physical disabilities. At the time of the inspection 30 people were using the service.

There was 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.

Risk assessments were not always in place to support staff to care for people safely. Some staff training required up dating and checking for competency.

There were sufficient staff to keep people safe and to be able to support people, however consideration of the deployment of staff throughout the service had not been identified.

Some areas of the providers quality monitoring systems were still not effective and the action plan for improvement had not been met in full.

People's medicines were administered and stored safely. People received their prescribed medication at the times they needed it by suitably trained staff.

People were protected from abuse as staff knew what constituted abuse and who to report it to if they suspected it had taken place.

The principles of The Mental Capacity Act 2005 were being followed to ensure that people consented to or were supported to consent to their care and support.

People had access to a range of health care professionals and were supported to attend appointments when required.

People’s nutritional needs were met, when people required extra support to eat and drink or a special diet, they received it.

Staff felt supported and were observed to be kind and caring to people and respect their right to privacy.

People who used the service and their relatives felt the manager was approachable and supportive.

During the previous inspection we looked around the home and identified some areas in need of redecoration and some items in need of replacement. At this inspection we saw that appropriate action had been taken.

We spoke with 11 people that lived in the home, three staff, a visiting district nurse and a relative. Five people who lived in the home told us they were settled and six people told us they well looked after. One person told us they were treated very well and enjoyed having a laugh with the staff. One relative told us, "I think they are well looked after here, I have no complaints". Three people told us they enjoyed their meals. One person told us, "We have nice food here, I like the homemade cakes".

Through observation we saw that people's privacy and dignity were protected; for example, staff knocked on bedroom doors prior to entering and people were offered choices of where to sit and what they would like to drink.

We saw that care records were completed to a good standard, with relevant risk assessments and reviews taking place. The district nurse told us, "The staff respond to our requests and keep us well informed".

We saw that people had a detailed care plan and appropriate risk assessments were in place. People's care was reviewed appropriately and professional advice was sought when necessary.

People living in the home chose from a well balanced 'home cooked' menu which was varied and appealing. People told us that the food was a credit to the cook and they looked forward to the mealtimes.

There were no outstanding complaints or safeguarding referrals at the time of the visit. People told us they felt safe in the home.

People told us that the staff were very kind and caring in their manner. We saw evidence that the staff training had improved and a training matrix was in place which will identify any future gaps and update requirements.

People that use the service and their relatives told us they were happy with the service, however we found that the auditing and quality assurance records did not demonstrate that sufficient monitoring was taking place.