This comprehensive inspection took place 15, 16, and 22 January 2019 and was unannounced.

At the previous inspection in November 2017, we rated the service overall as Requires Improvement. This was because mental capacity assessments did not contain enough information and the quality monitoring systems had not identified this. At this inspection, we found that the required improvements had been made and the service is now rated as Good.

Longbridge Deverill House and Nursing Home are two buildings on the same site. The house is a residential care home for up to 20 people and is located at the front of the grounds. The nursing home is situated towards the back of the grounds and up to 60 people can live there for residential, dementia, and nursing care. At the time of the inspection, 16 people were living in the house, and 56 people lived at the nursing home. Longbridge Deverill House and Nursing Home 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.

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. The registered manager and registered person were available throughout the inspection.

People told us they felt safe living at the home. People’s relatives felt confident that their family members received safe care.

Staff understood their responsibility to identify and report any concerns of abuse. Staff received safeguarding training. They told us they felt confident that action would be taken by any member of the nursing and management team in responding to concerns.

Risks to people’s safety were identified and assessed. Risk reducing measures were incorporated into people’s care plans, directing staff about how to avoid risks occurring.

There were enough staff to meet people’s needs. We observed staff responding to people’s needs promptly. People told us staff were there when they needed them. New staff were appointed through safe recruitment and selection processes.

Accidents and incidents were reported and analysed by the registered manager. Any trends or themes were identified. Where there were opportunities to learn from accidents or incidents, this was shared with the staff team. There were clinical governance meetings with the nurses, to reflect upon different aspects of their nursing practice.

Medicines were managed safely. Where people required creams or lotions to be applied, there were detailed plans for staff to follow. Technology was used in medicines management to ensure timely communication between the home, GP, and pharmacy.

People had received a health review from the GP, two months prior to the inspection. This was to ensure that medicines and care plans were reflective of their needs. All of the health and social care professional we received feedback from, praised the quality of care at the home. We saw that health and social care referrals were made in a timely manner.

Health and social care professionals told us that people with behaviours that other services had found challenging to manage, had notably improved. The registered manager told us that they supported successfully, a lot of people who had been “failed placements elsewhere”. This included reducing reliance upon medicines, where people had been overmedicated in other services.

People with diabetes received personalised care that had been effective for one person in reducing their reliance upon insulin. For another person, there had been significant improvements in their diabetic condition.

The home was well-maintained,

At the last inspection in January 2017 the service was rated inadequate. Following this inspection, we asked the provider to complete regular action plans to show what they would do to improve the key questions in Safe, Effective, Responsive and Well Led to at least good. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We discussed with the registered manager about ensuring there was continuous improvement in the delivery of care. While there had been improvements some areas needed time to embed into practices and to develop partnership working.

The Longbridge Deverill site provides care to 20 older people at Longbridge Deverill House located at the front of the grounds. Towards the back of the grounds is a 60 bedded nursing home divided into two purpose built units for people with general nursing needs and dementia care needs. 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.

A registered manager was 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 supported to have choice and control of their day to day lives and they were supported by the staff to make some decisions. Documents showed staff lacked an understanding on when they were to assess people’s capacity to make complex decisions. For some people the staff reached best interest decisions without consulting families and where lasting power of attorney were in place these individuals were not consulted.

Quality assurance systems were in place and action plans were developed on how shortfalls identified through audits were to be met. However, audits had not identified that frameworks to gain consent from people identified as lacking capacity were not meeting the principles of the Mental Capacity Act 2005.

Safeguarding procedures were in place. People told us they felt safe and staff told us they had attended safeguarding of vulnerable adults from abuse. The staff we spoke with knew the types of abuse and the actions they must take for reporting alleged abuse.

Systems were in place to identify and manage potential harm . Risk assessments to support people to take risks safely were devised and regularly reviewed.

Staffing levels were well maintained. There were sufficient staff to meet people's needs and staff had time to spend with people.

People received their medicines safely. Medicine administration records (MAR) sheets were signed to indicate when medicines were administered. Where people were prescribed medicines with specific instructions for administration we saw these instructions were followed.

People received effective care from staff who had the skills and knowledge to support them and meet their needs. Staff attended training set as mandatory by the provider and attended refresher training when the training had become outdated or expired. Staff had regular meetings with their line manager to discuss their performance, concerns and training needs.

People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

Arrangements were in place to maintain the environment clean and we found the home wa

Longbridge Deverill House and nursing home are two separate buildings set on one site and overall are registered as one service to provide either personal care or nursing care for up to 80 people.

Longbridge Deverill House is an older style property and offers accommodation and personal care. At the time of our inspection there were 17 people living at Longbridge Deverill House. Directly behind the house is another newer building which provides accommodation for people who require personal and nursing care. The nursing home is divided into four units which support people with varying levels of health needs. There were 56 people living in the nursing home at the time of the inspection. The service did not have a registered manager in place, however a new manager had started in November 2016. The manager was intending to register with CQC.

We looked at the concerns raised and found the provider had not protected people from the risk of harm and abuse as some people were being unlawfully restrained as a means of managing their behaviour.

There were systems in place to ensure that medicines were administered safely and people received their medicine on time and in a place of their choosing. Stock levels were correct and disposal of medicine were managed in line with the provider policy.

People and their families told us staff were kind, considerate and caring. However, due to the concerns we found around restraint we did not find this to always be the case. We observed people had developed positive relationships with staff and people told us they felt safe.

There was a lack of equipment to ensure safe infection control practices could be followed. Not all areas of the environment or premises were safe and suitable for the intended use.

Staffing levels were not determined by the needs of people which resulted in people not always receiving timely and appropriate care and support. People told us they liked the staff.

There was a varied range of nutritious food available and people told us they enjoyed their meals and had sufficient to eat. Within some units of the nursing home we found the meal times were not organised enough to ensure people received appropriate support.

Staff supervision was not routinely being carried out and appraisals had fallen behind. Staff told us the training they received was good, however a course intended to enable staff to help people manage their behaviours was not appropriate. This led to a culture of staff perceiving it was in the best interests of people to restrain them when they became agitated. We found the lawful process intended to protect people from abuse had not been followed.

There were varying levels of understanding from staff around the Mental Capacity Act 2005 and the provider had failed to ensure that due process was followed in line with the Act.

People had access to a range of activities and social interaction however some people did not receive appropriate stimulation, social interaction and meaningful occupation if they did not wish to participate in the activities on offer.

Care plans were not person centred and lacked information about how to enable and support people with maintaining daily living skills and their independence. Care records were inconsistently completed between different areas of the service and lacked detail about people’s care and support. Care plans had not been effectively reviewed to ensure their current needs and preferences were known. The monitoring of people’s care and support was inconsistent.

Quality assurance systems, governance and the audits in place had identified some of the concerns we found, however remedial action had not been taken to address the shortfall. Other concerns we raised were not identified by the quality assurance systems in place.

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

We saw the provider had a system to monitor the quality of the service. We found there were regular audits of medicine administration records (MAR) and care plans.

People's complaints were recorded and addressed.

People's views of the service were collected and action taken where needed.

Incidents and accident reports were up to date. Essential risk assessments had been completed.

We carried out this inspection to look at improvements following our inspections of 14 February 2012 and 17 April 2012.

We found people were now consulted about their care, with proper processes in place if people could not decide for themselves. Care plans were more detailed about how people’s needs were being met and monitored.

We found people were receiving appropriate support with behaviours because behaviour management plans were in place. We found people were being moved safely because staff had received further training and their competence was being regularly monitored.

We found staff were aware of when we must be notified of incidents as required by regulation.

After the inspection of 14 February 2012, the manager sent us an action plan with details of what was being done to improve the service.

After our Pharmacist inspection of 17 April 2012 the provider sent us an action plan with details of actions taken to address our findings. At this inspection we found the arrangements for safe administering and control of people’s medicines had been reviewed, revised and members of staff made aware of the risks through training and supervision.

People told us they were happy with the staff looking after their medicines for them. One person told us they were given their medicines at the particular times they were needed.

We made this visit because we had been given information from different sources which raised concerns about the care and welfare of people who use the service.

We had been given information that some people were being bathed early in the morning against their wishes. People told us that they had baths at different times of the day and the records supported this. We could find no evidence that people were bathed against their wishes.

Statements that some people were resistant to care did not have supporting guidance in their care plans about how this was to be managed for their continued well being.

We had been given information that that the manager had withheld one person's medicine for a week. We found that this had happened on one occasion with no written explanation. However there were other times when the person had been given this medicine each time it was prescribed. Some of the handwritten entries in medicine records were not always dated. We have asked our Pharmacist Inspector to carry out a more detailed inspection of Outcome 9.

We had been given information about poor moving and handling practice with bruising to people and the wrong equipment being used. We saw one example of poor moving and handling. We could not find any bruising that was attributed to poor moving and handling. Care plans only identified a list of equipment to be used with no detailed guidance on how to help move the person.

We had been given information that the service was short staffed and some shifts were not covered when staff failed to turn up. We found occasions when there had not been the full complement of staff. The manager explained that some staff had been dismissed during an investigation and difficulties had been experienced in covering all their shifts.

Care plans were regularly reviewed and updated when people's needs changed.

New members of staff were inducted with a detailed record of the areas covered.

When we inspected there were 44 people living in the homes. We spoke with 11 people who use the service, one relative and eight staff. We also made our own observations during the visit.

People who use the service told us they were satisfied with the service they received. People felt the staff supported them and met their needs. One person using the service said "we are looked after very well."

People told us that staff treated them with dignity and respect. One person said “I was flabbergasted by their kindness.” We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live in the home. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Recruitment records showed that new staff had been checked to ensure they were suitable to work with vulnerable people. The home trained their staff and had procedures which protected people from abuse. People told us they did not have any complaints but were uncertain of who to speak to if they were concerned. One person said “I suppose it’s my keyworker” whilst another said “I don’t really know.”

The service and the building were monitored and risk assessed to ensure they were suitable for the people using them.

The evidence we collected showed us the service kept people safe and met their care needs.