Archived: Longmore Nursing Home

Longmore Nursing Home is a care home. It provides personal and nursing care for up to 22 older people in one building. At the time of our inspection 21 people lived at the home.

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

People felt safe living at the home and safeguarding procedures were in place to protect people from harm.

Staff were recruited safely, and enough staff were on duty to provide safe care during our visit. People felt staff had the skills they needed to support them effectively.

People and relatives spoke positively about the way staff administered their medicines. However, previously demonstrated standards of medicines management had not been maintained. We found staff did not always follow safe administration practices. Immediate action was taken in response to our findings.

Quality assurance processes were not always effective to drive forward improvement. Checks had not identified the issues we found. The registered manager understood their responsibility to be open and honest when things had gone wrong. They welcomed our inspection feedback and took immediate action in response to the issues we found.

People, relatives and staff spoke highly of the registered manager and the positive culture they created. Whist people confirmed they could talk to the managers at any time we found more could be done to engage people. People and relatives felt comfortable raising concerns with staff and managers at the home.

People's needs were assessed before they moved into the home to make sure it was the right place for them to live. Care plans demonstrated the inclusion of people and those closest to them which helped staff to provide personalised care. However, plans had not always been updated when people’s needs had changed.

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. However, whilst staff understood the importance of offering people choices we saw this did not always happen in practice.

People and relatives spoke positively about the level of care they received. People were encouraged to be independent. Care was provided in a dignified way and people’s right to privacy was respected. Staff received training to support people as they neared the end of their lives.

The home environment met people’s needs. Plans were in place to refurbish the conservatory area to benefit people. The home was clean and tidy, but the management of risk related to infection control required improvement.

People were provided with information in a format they could understand, and signage helped people to locate their way around the home. Overall, people were satisfied with the social activities provided to occupy their time.

People liked the food. However, staff did not support some people to eat their meals in the best way possible. People confirmed they had access to health professionals when needed to maintain their health and wellbeing.

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

Rating at last inspection

The last rating for this service was good (published 17 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safety and the governance of the home at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 11 January 2017 and was unannounced. The service was last inspected on 12 November 2015 when we found some improvements in relation to the quality and safety of the service were required.

A registered manager had been in post for over 12 months. 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 told us they felt safe living at the home and we saw enough staff were on duty to keep people safe and meet their needs. Since the last inspection new staff had been recruited and changes had been made to ensure people received consistent care. People spoke positively about the support they received from the consistent staff team.

The provider's recruitment procedures minimised the risk to people's safety of unsuitable staff being employed. Staff understood their responsibilities to protect people from harm and felt confident to raise any concerns. Risk assessments and management plans were in place to minimise the risks to people's safety. Staff knew people well and clear guidance was in place for staff to follow to manage the identified risks. Our discussions with staff demonstrated a consistent approach to the management of risks.

People received their medicines as prescribed. Medicines were administered safely by qualified nurses. However, the storage of some medicines required improvement.

Since the last inspection staff had completed further training to support them carry out their roles safely and effectively. New staff received an induction prior to working unsupervised and staff received training in health and social care to develop their skills further.

Since our last inspection the home manager had increased their knowledge in relation to the Mental Capacity Act (2005). They understood their responsibility to comply with these requirements. Since the last inspection ‘decision specific’ capacity assessments had been completed for those people who lacked capacity, so suitable decisions could be made in their best interests. The correct action had been taken for restrictions in people's care to be authorised. Staff understood their responsibility to seek people's consent before they delivered care.

People enjoyed the varied social activities that were available. Mealtime experiences were enjoyable for people and they received a varied and nutritious diet. Where necessary, specialist diets were catered for and people were supported to eat. Staff demonstrated a good understanding of people's nutritional needs. The staff team worked closely with external healthcare professionals to ensure people's health and wellbeing was promoted and maintained.

There had been significant improvements to the systems in place to monitor the quality of the service provided since our last inspection. Analysis of incidents and accidents took place to identify any patterns or trends to reduce the likelihood of further incidents occurring. People were more involved in planning their care since the last inspection and care plans contained more detailed information about people. This meant care was provided in a personalised way.

People told us care workers showed them kindness and they had the correct skills and experience to provide the care and support they required. People received care from staff who were respectful and ensured people's privacy and dignity was maintained. Relatives and visitors were welcomed at the home and were encouraged to be actively involved in people's lives.

People knew how to complain and said that the management team listened to them and responded promptly to their requests. People and their relatives were confident concerns would be dealt with appropriately and fairly.

Staff enjoyed working at the home and felt supported to do their work by the management team. People, their relatives and staff told us the home manager was approachable and they were happy with the way the home was run.

The provider and the home manager promoted an open culture by actively encouraging feedback from people, their visitors and staff to put forward their suggestions to make continual improvements at the home. Action was taken to ensure the home was run in-line with people's wishes.

Longmore Nursing Home provides care and accommodation for up to 22 older people. There were 21 people living at the home at the time of our inspection. Nursing care is provided and this includes a small number of people living with dementia.

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 time of the inspection the registered manager had recently left their employment at the home and a new manager was in post.

Staff were available at the times people needed them, however frequent changes in staff did not always ensure continuity of care. There were a number of staff vacancies and plans were in place to address this. The number of staff on duty had increased recently and staff vacancies were covered by agency staff until the time that new staff were recruited. Staff had received training so that, overall people’s care and support needs were met. Further staff training was planned.

Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks.

People were involved in decisions about their care and told us that they received support in the ways they preferred. People were happy with how their personal care needs were being met and told us that staff encouraged them to remain as independent as possible. Group social activities were arranged, however people had limited opportunities to pursue their individual hobbies and interests. Plans were in place to address this. People were supported to maintain relationships with people important to them and visitors were welcomed at the home.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. However, ineffective communication between the staff team had resulted in a delay in some people receiving dental care and treatment. Medicines were managed so that people received their medication as prescribed, however improvements were needed in relation to the recording and disposal of medicines.

Staff understood the principles of the Mental Capacity Act (MCA), and care workers gained people’s consent before they provided personal care. The manager told us that as they were new at the home they would liaise with the Local Authority in order to discuss the MCA further.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. This was through regular communication with people and staff and a programme of other checks and audits. Due to the recent management changes at the home quality monitoring had lapsed recently, however plans were in place to address this. The management team ensured actions were taken following suggestions put forward, for the benefit of people who lived at the home.

We observed staff generally interacting with people with kindness. However we saw some people were not always treated with dignity.

We saw some people's risk assessments and care plans did not always reflect their needs.

We saw most people were supported with safe management of medicines. However not all medicine charts were completed accurately and one medication was stored below the recommended safe temperature level.

We saw most of the equipment provided was safe for people to use, however during our inspection we saw several items of equipment were out of order.

We spoke to three people who used the service. They told us they were happy with their care. One person stated, 'The carers are warm and friendly and nothing is too much trouble.'