Archived: Longfield Manor

Longfield Manor is a residential care home and provides personal and nursing care for up to 60 people. At the time of inspection, 28 people were living at the service in three separate wings. People were aged 60 and over and lived with a range of mental health and physical health needs including age related frailty, diabetes and degenerative conditions such as dementia and Parkinson’s disease.

The building was purpose built over two floors. The building and courtyard garden were fully accessible, and the first floor was accessed by a lift. One of the wings specialised in providing care to people living with dementia.

Longfield Manor is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation in relation to incidents that occurred between 2016 and 2018. The investigation is on-going, and no conclusions have yet been reached. These investigations do not include Longfield Manor.

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

There was not an adequate process for assessing and monitoring the quality of the services provided and ensuring that records were accurate and complete. People’s epilepsy was not always managed safely, and we have made a recommendation to the provider about this. Processes for clinical oversight were not robust to identify discrepancies with people’s medicines.

The service was welcoming, and people told us that they felt safe. They said there were enough staff to look after them and they were listened to and treated with kindness. Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns.

Positive and caring relationships had been developed between staff and people. People were treated with kindness and compassion and staff were friendly and respectful. People and their relatives spoke positively about staff and the care they received. People were treated with dignity and respect by a kind, caring staff.

Since the last inspection a new manager has been appointed. The new manager commenced in September 2020 and are in the process of registering with the Care Quality Commission to become the registered manager for the service.

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.

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 requires improvement (published 7 May 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 and 18 February 2020. A breach of legal requirements was found in relation to Regulation 17, Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when, to improve their governance processes.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection. This is the fifth consecutive inspection where the service has been rated requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Longfield Manor on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 17 , Good governance.

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 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

Longfield Manor provides support and accommodation for up to 60 people who require assistance due to frailty of old age and health care needs. There were 36 people living at the home at the time of the inspection. Some people were living with dementia and others needed support with daily living including washing, dressing and mobilising safely. The home has two floors and all bedrooms were single occupancy. There are a number of communal areas that people shared such as lounges, a dining area and a café. A passenger lift enables people to access all parts of the home. There is a separate wing to accommodate people living with dementia, the Rosewood Unit. There is a garden that is accessible to people using walking aids and wheelchairs.

Longfield Manor is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation in relation to incidents that occurred between 2016 and 2018. The investigation is on-going, and no conclusions have yet been reached.

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

The registered manager was experienced and was focused on continuously learning and making improvements to the home and had worked hard to improve the culture and ethos in the service since the last inspection. However, some audit and quality assurance processes were still not sufficiently robust and had not identified inconsistencies in some documentation and practice which were identified during the inspection. While we found the risk to people was reduced as permanent staff knew them well, this is an area that required improvement to ensure effective monitoring and quality assurance.

Care plans varied in quality and there remained a lack of consistency and holistic approach to care planning. The registered manager was transparent about work still in progress and areas that required improvement.

People continued to have access to activities, and while the service had made improvements, more work was needed to ensure that people could enjoy activities that were person-centred and reflected their interests and preferences.

People were supported to eat and drink a healthy balanced diet to meet their individual needs and preferences. People with risks around food were supported to eat safely. We have made a recommendation about improving the mealtime experience for all people living at Longfield Manor.

The environment continued to meet most people's needs and the home had enough room for people to move around safely. The provider was investing to improve the facilities and environment to ensure the service continued to meet people’s needs as these changed over time. We have made a recommendation about considering the needs of people living with dementia when undertaking changes to the environment.

Risks to people were assessed to keep them safe. This included potential risks related to their health, or risks from the environment. We have made a recommendation about improving systems of analysis around behaviours that may challenge and accidents and incidents.

People received care and support from trained staff who knew them well. The provider used safe recruitment practices. People received their medicines safely from staff who were trained and competent to do so.

People were supported to maintain their health and had assistance to access health care services when they needed to. People had access to services such the GP, speech and language therapists (SALT), dentists and others. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they felt safe and knew who to contact if they had any concerns. People remained protected from avoidable harm. There was a safeguarding policy and staff received training. Staff knew how to recognise the potential signs of abuse and knew what action to take to keep people safe.

There was enough staff to support people safely and the provider had safe recruitment procedures and processes in place.

People were protected by the prevention and control of infection. Staff received training and wore gloves and aprons when supporting people.

The registered manager had created an open and positive culture and staff knew people well. Staff felt well supported and the home had a warm and welcoming atmosphere. Staff had developed positive relationships with people, and we observed friendly, warm and caring interactions between the staff and people. People told us that the staff were kind and treated them with respect.

The provider had a complaints policy in place. The complaints procedure was displayed in the home. People and relatives knew how to make a complaint and told us that they would be comfortable to do so if necessary.

People received compassionate and dignified end of life care that respected their wishes. People were proactively supported to maintain relationships with people who were important to them.

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

Rating at the last inspection:

The last rating for this service was Requires Improvement (report published 28 May 2019)

Why we inspected:

This was a planned comprehensive inspection scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care.

Enforcement:

This is the 4th consecutive inspection where Longfield Manor has been rated Requires Improvement. At the last inspection we found five breaches of regulation. At this inspection four of those breaches have been met and we have identified one continuing breach of Regulation 17 in relation to good governance. 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.

We had previously imposed conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections.

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.

• Longfield Manor is a care home that provides nursing and residential care. Longfield Manor is registered to provide nursing and accommodation for up to 60 people. People cared for were older people who needed nursing care, some people had complex health needs, and/or some people were living with dementia. At the time of our inspection there were 48 people living at the service.

• Accommodation is provided across the main building which is split into three areas and Rosewood unit. Rosewood is a unit for people living with dementia. All bedrooms were of single occupancy. People shared communal areas such as lounges and a large dining room.

• Longfield Manor is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is ongoing, and no conclusions have yet been reached.

• At the previous inspection in July 2018 we found four breaches of regulation in relation to safe care and treatment, staffing, person-centred care and governance. At this inspection we found that the provider continued to be in breach of these four regulations and was in breach of one new regulation in relation to dignity and respect.

People’s experience of using this service:

¿ The service met the characteristics of ‘requires improvement’ in each domain inspected. This meant that the provider needed to make some improvements to people’s support. These are detailed below.

¿ Some aspects of the service did not ensure that people remained safe from harm. There were elements of moving and handling practices that did not always ensure the safety of people at the service. The provider had not always fully assessed, and mitigated the risks, associated with repositioning people and the periods that people spent in their wheelchairs.

¿ The provider did not always ensure that staff had the training and skills to meet some of the needs of people who lived at the service.

¿ People’s dignity was not always promoted by staff.

¿ People did not always receive personalised support because peoples likes, dislikes and preferences had not always been identified and used in the care planning process. However, the provider had made improvements in the provision of activities and social engagement for people.

¿ Systems of governance and quality assurance were not always effective in highlighting shortfalls in the service.

¿ People’s health needs were met with the support of staff. Staff worked in partnership with other organisations to ensure people's needs were met.

¿ People medicines were administered and managed safely and effectively.

¿ People were supported to eat enough food and drink. People who required additional help to safely manage their nutritional needs were supported effectively by staff.

¿ Staff had made appropriate checks and carried out maintenance to ensure the service and equipment was safe for the people living at Longfield Manor.

¿ People received compassionate and caring end of life support. People’s complaints were addressed and dealt with appropriately.

¿ Recruitment processes were robust and ensured staff were safe to work with people before they started working at the service.

¿ People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

¿ People, their family members and staff told us that the management were responsive and had taken steps towards implementing improvements at the service.

More information is in the detailed findings below.

Rating at last inspection:

• At our last inspection in July 2018, the service was rated "requires improvement". Our last report was published in February 2019. This is the third time the service has been rated as requires improvement overall.

Why we inspected:

• All services with rated as requires improvement with breaches are re-inspected within twelve months of our prior inspection. However, this inspection was brought forward in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service.

Enforcement: Please see the 'Action we told provider to take' section towards the end of the report. We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have been made. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and July 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Longfield Manor is a care home that provides nursing and residential care. 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 and both were looked at during this inspection.

Longfield Manor is registered to provide nursing and accommodation for up to 60 people. People cared for were older people who needed nursing care, some people had complex health needs and/or some people were living with dementia. At the time of our inspection there were 44 people living at the home. Accommodation is provided across the main building which is split into three areas and Rosewood unit. Rosewood is a unit for people living with dementia. All bedrooms were of single occupancy. People shared communal areas such as lounge’s and a large dining room.

A manager was in post who had applied to become the 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.

At the last inspection in July 2017 we found the provider was in breach of Regulations associated with safe care and treatment, staffing and governance. The provider told us the action they were taking to meet the legal requirements. At this inspection we identified further improvements were required and the provider remained in breach of Regulations. We found risks were not always managed safely on behalf of people. We also found agency registered nurses were not always adequately trained to assist them in carrying out their role and responsibilities effectively.

Some group activities were offered to people. However, personalised activities and occupation were not consistently provided and information was not always in an accessible format. We observed caring approaches were not consistently applied and we made a recommendation to the provider about this. Systems were not always effective in measuring and monitoring the quality of the service provided. There were ineffective systems in place to drive continuous improvement.

People's consent to care and treatment was gained in line with the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and for staff to support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received supervisions and appraisals and they found the manager’s approach supportive.

People were provided choices daily regarding what food they ate and clothes they wore. Complaints were managed effectively. The provider sought feedback from people and their relatives regarding the care received and they spoke positively about the care provided.

The manager had sought information about the new Key Lines of Enquiry (KLOE) which the Commission introduced from 1 November 2017. They were keen to improve the quality and safety of care provided to people living at the home.

At this inspection we found the service was in breach of four of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three of these breaches were continuing from the last inspection therefore the service remains rated as Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.

The inspection was bought forward as we had been made aware that following the identification of risks relating to people's care, the service had been subject to a period of increased monitoring and support by commissioners. The service has been the subject of 16 safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. However, we used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May and August 2017, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Longfield Manor provides nursing care and is registered to accommodate up to 60 older people with a variety of physical and mental health needs. In the main building 14 beds are within a unit called Rosewood, which cares for people living with dementia. At the time of the inspection there were 39 people living in the main building and 11 people living in Rosewood. Bedrooms all have an en-suite toilet and sink. There are four lounges, a quiet room and a spacious dining room that overlooks well- tended gardens. Rosewood has its own lounge/dining room and access to a secure garden area.

We carried out an unannounced comprehensive inspection of this service on 11 October 2016 where it was awarded a rating of ‘Good’ in all domains apart from the ‘Safe’ domain which was rated ‘Requires Improvement’. No breaches of regulations were identified but recommendations to improve aspects of medicines management were made. An overall rating of ‘Good’ was awarded.

During our inspection the registered manager was present. 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.

Whilst systems were in place to assess, monitor and improve the quality of the service, these were not always effective, as they had not identified the breaches of regulation we found at the time of our inspection. The deployment and routine of staff in the morning meant that some people’s preferences, for example when they were assisted to get up, were not met. This issue had not been identified in any of the audits and checks completed by the provider or registered manager. Aspects of medicines management were not robust and these had not been identified by the provider or registered manager, despite monthly audits having taken place. Audits had not identified quality issues and safeguarding concerns prior to the intervention of outside agencies. However, they had identified that staff had not received formal supervision and training but insufficient action had been taken to address this at the time of our inspection. There was evidence of improvements having been made in accurate record keeping, but further work was still needed.

The provider had increased the numbers of staff on duty in order to help address some of the quality and safeguarding concerns raised by West Sussex County Council (WSCC). As a result there were sufficient numbers of staff to provide safe care. However, staff were not deployed effectively to meet people’s needs. Some people who required assistance from two staff due to moving and handling needs were routinely left until staff had assisted people who only required assistance from one staff member. This did not promote personalised care.

Staff said that they felt fully supported and that the registered manager was approachable. They said that they received sufficient support and training to undertake their roles and responsibilities. However, we found that, despite a training programme being in place, some staff had not completed annual safeguarding, Mental Capacity Act or dementia training as required by the provider. Some nurses had not completed training relevant to the needs of people who lived at the home. Further training had been arranged to take place later in the year. However, the registered manager was unable to demonstrate how she ensured staff with sufficient knowledge and skills were deployed on each shift.

People who were able told us that they felt safe and staff that we spoke with were able to explain the correct safeguarding procedures that they should follow if they thought a person was at risk of harm or abuse. Prior to this inspection, the registered manager shared with us action plans and details of steps that had been taken in response to the concerns raised by WSCC. At this inspection we found that, in the main, the action plans had been acted upon and safety and quality issues improved. Senior management shared learning from safeguarding situations that had occurred at other locations operated by the provider to ensure learning and practice improved across the organisation. As a result of the safeguarding situations, the provider had sourced a safeguarding expert and a new system was being implemented to ensure appropriate action was taken when incidents and events occurred. Regular meetings and communications were taking place with senior management and registered managers where safeguarding situations were being discussed and learning shared. The provider wanted to work collaboratively with other agencies. However we remain concerned that action to safeguarding service users was prompted by the feedback from external agencies rather than proactive monitoring of people’s safety.

In the main, risks to people’s safety and wellbeing were managed appropriately. Where required sensor mats were either next to beds or chairs that people were using. These alerted staff to people’s movements who had been identified as being at risk of falls. People who were at risk of malnutrition or dehydration had drinks to hand and were given snacks and fortified meals. People who were at risk of developing pressure sores had pressure relieving mattresses in place that were set at the correct setting for their weight. Assessments, care plans and monitoring records were in place. However, some records were not accurate. By observing the care being delivered and talking to people and staff, we were satisfied this did not impact on people’s safety, but was a records issue that could affect the quality of service provided.

People in the main, said that staff were kind and caring. We observed several occasions where care staff demonstrated a compassionate attitude with people. Staff spoke politely to people with lots of conversations heard. We observed staff knocking on doors and waiting for a response before entering and ensuring doors were closed when assisting people with personal care. Staff had ensured that people who were being cared for in bed had clean bedding and some had gentle music playing. Good attention had been paid by staff to people’s personal appearance. We did observe two occasions when staff did not demonstrate a caring approach which we brought to the registered managers attention during our inspection.

People’s views on management of the home varied but people did say that the registered manager was nice and friendly. Throughout our inspection we found the registered manager to be open and transparent. She had made arrangements to increase the frequency of residents and staff meetings and during these had discussed the concerns raised by WSCC in an effort to be transparent.

Checks on the environment and equipment were completed to ensure it was safe. This included equipment used to help people to transfer. Where people required assistance to move using a hoist their records included details of the specific hoist and size of sling to be used, and we observed the sling to be in their room. As a result of the concerns raised by WSCC the registered manager had purchased additional bed rail covers which reduced the risk of entrapment and we observed these to be in place.

The home operated within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and staff put this into practice. Mental capacity assessments had been completed for people where required. Throughout the inspection staff were seen seeking people’s consent and were able to explain what consent meant when we discussed this with them.

People had access to a range of healthcare professionals and services. People had access to a GP who visited the home on a weekly basis, to community psychiatric nurses, community Parkinson’s disease nurses, and other community health professionals. Weekly clinical meetings took place where the nurses and registered manager reviewed the needs of individuals to ensure nursing care provided was effective.

People said that their concerns and complaints were listened to and acted upon. Three people expressed the view that improvements could be made in this area to reduce themes reoccurring. Feedback was obtained from people and their relatives through formal questionnaires and residents’ meetings. Arrangements had been made for the frequency of meetings to increase from bi monthly to monthly and for these to be linked to an activity as it had been identified that more people attended when activities were involved. During the June 2017 meeting people’s views were obt

Longfield Manor provides nursing care and can accommodate up to 60 older people with a variety of physical and mental health needs. Fourteen of the beds are within the Rosewood unit, which cares for people living with dementia. There were 54 people in residence at the time of our visit, including 14 in Rosewood.

The service did not have a registered manager. The registered manager had left in September 2016 and was in the process of deregistering. 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. In the absence of a registered manager, the deputy manager was overseeing the service with support from a representative of the provider.

Medicines may not have been consistently administered. We have made a recommendation about reviewing written guidance relating to medicines. This was because information on how specific medicines should be administered was missing or lacked detail. This could have an impact on the consistency of support that people received, especially when temporary staff were involved in administering medicines.

People, relatives and staff spoke of improvements in the service and a reduction in the number of agency staff used. We found, however, that the changes in the staff team and the relatively high use of temporary staff was still impacting on people’s experience. The provider was actively recruiting to the vacant positions and tried wherever possible to use the same members of agency staff to promote continuity.

People told us they felt safe at the service and that staff treated them respectfully. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned someone was at risk of abuse. Risks to people’s safety were assessed and reviewed.

People had developed good relationships with staff and had confidence in their skills and abilities. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training which helped them to improve the care they provided to people.

Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

The home included a dementia community known as ‘Rosewood’. A team leader had been appointed to run this part of the service. They had made improvements to the care and the home environment which was having a positive effect on people’s wellbeing.

People told us the meals at the service were improving and that the new Chef was listening to their feedback and suggestions. Staff monitored people’s weight to ensure they were receiving enough to eat. Where concerns were identified, action had been taken to ensure people had adequate food and fluids.

Staff responded quickly to changes in people’s needs and adapted care and support to suit them. Where appropriate, referrals were made to healthcare professionals, such as the GP or dietician, and advice followed.

People were involved in planning their care but on-going involvement had not always been recorded. The deputy manager was planning to introduce six monthly reviews to ensure that staff actively sought input from people and, where appropriate, their families.

There was an established system in place to monitor and review the quality of care delivered and to make improvements. People, their relatives and staff felt confident to raise issues or concerns. Where improvements had been identified action had been taken or was underway.