Longcliffe Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Longcliffe Nursing Home provides personal care and accommodation for up to 42 older people some of whom have dementia. On the day of our inspection there were 26 people living at the service.

At the last inspection in October 2017 we found two continued breaches of the regulations. The service was rated overall Requires Improvement with an Inadequate rating in the Well led domain and a Requires Improvement rating in the Safe, Effective and Caring domains. The service was placed in special measures.

We inspected again on 24 and 25 July 2018. The first day of our visit was unannounced. This meant the staff and the provider did not know we would be visiting. During this inspection we found the provider had implemented the necessary improvements. At this visit we found evidence to demonstrate and support the overall rating of Good. The service is no longer in special measures.

The service had 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 told us they felt safe living at Longcliffe Nursing Home. The staff team had received training on the safeguarding of adults and were aware of their responsibilities for keeping people safe from avoidable harm.

People's care and support needs had been identified and the risks associated with their care and support had been assessed and reviewed. Plans of care had been developed for each of the people using the service and the staff team knew the needs of the people they were supporting well.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong to improve safety across the service.

Checks had been carried out when new members of staff had been employed to check they were suitable to work at the service. Staff members had received an induction into the service and relevant training had been provided enabling them to properly support the people using the service.

People told us the staff team were kind and caring and treated them with respect. Observations made during our visit confirmed this.

The staff team supported people to make decisions about their day to day care and support and always obtained people’s consent to their care. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

Whilst people were provided with their medicines safely, GP instructions had not always been followed. Protocols were in place and followed with regards to medicines prescribed ‘as and when required’.

The staff team had received training on infection control and followed best practice guidance in preventing the spread of infection. We saw personal protective equipment such as gloves and aprons were readily available and these were used by the staff team throughout our visit.

Most areas of the service were clean and tidy.

People's food and drink requirements had been assessed and a balanced diet was being provided. People received on-going healthcare support and had access to the relevant healthcare services.

Staff members felt supported by the management team and told us there was always someone available to talk with should they need guidance or support.

People knew who to talk to if they had a concern of any kind. A formal complaints process was in place and people were confident that any concerns they had would be taken seriously and acted upon.

Relatives and friends were

This was an unannounced comprehensive inspection that took place on 16 October 2017.

At our last inspection on 3 and 6 February 2017 we found two breaches of legal requirements and rated the service as Requires Improvement. After this inspection the provider wrote to use to say what they would do to meet legal requirements in relation to a breach in Good governance and Requirement as to display ratings. At this inspection we found the service had made some of the required improvements. However the rating for the service remained Requires Improvement. We found two continued breaches of the regulations.

Longcliffe Nursing Home provides accommodation, care and support for up to 42 people who require personal care. During our inspection 18 people were using the service. The home is located on two floors with lift access to both floors.

The service had 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’s equipment was regularly checked, however actions to repair equipment were not always carried out. Audits on the environment had not always been recorded to show checks had been completed. There were plans to keep people safe during significant events such as a fire.

People were protected from the risk of harm because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to report any concerns they had about people’s welfare.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where risks had been identified control measures were in place.

There were enough staff to meet people’s needs. People sometimes had to wait for support however staffing levels had been assessed and staff could respond to people’s requests for support. The provider had safe recruitment practices. This assured them that staff had been checked for their suitability before they started their employment.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. Staff had been trained to administer medicines and had been assessed for their competency to do this.

Staff received appropriate support through an induction, support and guidance. There was an on-going training programme to ensure staff had the skills and up to date knowledge to meet people’s needs.

People received enough to eat and drink. Records of what people had eaten were not accurately recorded. They had access to a variety of meals, snacks and drinks.

People’s health needs were met. This is because staff supported them to access health care professionals promptly. Staff also worked with other professionals to monitor and meet people’s needs and support them to remain well.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that assessments of mental capacity had been completed; however these had not been reviewed and were not always based on a specific decision. Staff told us that they sought people’s consent before delivering their support.

People were involved in decisions about their support. They told us that staff treated them with respect, however there were times when people were not always treated with

dignity. Staff usually treated people with kindness and compassion.

People received care and support that was responsive to their needs and preferences. Care plans provided information about people so staff knew what they liked and enjoyed. People were encouraged to maintain and develop their independence. People took part in activities they enjoyed. People did not alway

We inspected Longcliffe Nursing Home on 3 and 6 February 2017. The first day of the inspection was unannounced. This meant that the staff and provider did not know that we would be visiting. We told the provider we would be returning for the second day.

Longcliffe Nursing Home provides accommodation, care and support for up to 42 people who require personal care. During our inspection 24 people were using the service. Since our last inspection on 6 June 2016 the provider had chosen to no longer provide nursing care at Longcliffe Nursing Home and had deregistered this regulated activity in October 2016. The home is located on two floors with lift access to both floors. The home has two communal lounges and a dining room. During our inspection the lounge upstairs was in the process of being decorated so was not in use.

The service had 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.

At the last inspection we carried out on 6 June 2016 we found that the provider had not met the regulations relating to good governance. At the inspection we found the provider had made some of the required improvements.

People were not always protected from risks relating to their health and safety. We found that not all risks had been fully assessed and control measures identified.

People were protected from the risk of abuse because staff could identify the potential signs of abuse and knew how to report any concerns. Accidents and incidents were recorded and reviewed to identify the cause to try and reduce the risk of reoccurrence.

Staff had not always been recruited safely. Pre-employment checks had not been thoroughly carried out before staff started to work at the service. These are important to make sure that staff are suitable to work with people who may be vulnerable. There was enough staff to keep people safe.

People’s tablets and liquid medicines were stored safely. Where medicines were taken as and when required these had not been given in accordance with the protocol in place. Creams and liquids had not always been dated when opened.

Staff received support through an induction to the service and supervision. There was an on-going training programme to provide and update staff on safe ways of working. We found staff had not all completed training to give them the guidance and knowledge to meet the needs of people who used the service.

People were supported to access healthcare services. People were given sufficient to eat and drink. Where people’s food intake needed to be monitored to reduce the risk of malnutrition the amount of food people had been given was not recorded. Where people had a specific diet this was not always followed.

People were usually asked for their consent before staff supported them with personal care. Where there was a reasonable belief that someone did not have the capacity to make a specific decision an assessment of their capacity had sometimes been completed. Where a decision had been made that was believed to be in a person’s best interests the details of this had not been recorded.

People told us that the staff were kind. Staff members knew people well and were able to tell us about their likes and dislikes. Staff did not always pass private information to other staff in a discreet manner. Staff did not always respect people’s choices in relation to their likes and dislikes.

Relatives and friends were able to visit when they wanted to and were made to feel welcome.

People took part in a range of activities that they enjoyed. Some people told us that they would prefer some other activities.

People had contributed to an assessment of their needs when they started to use the ser

We inspected Longcliffe Nursing home on 6 June 2016. This was an unannounced inspection. This meant that the staff and provider did not know that we would be visiting.

Longcliffe Nursing Home provides both personal and nursing care for up to 42 people who are aged over 65 and who may also have a physical disability. The home is located on two floors with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 25 people were using the service.

We carried out an unannounced comprehensive inspection of this service on 14 and 15 December 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to a breach of Regulation 12 safe care and treatment, and a breach of Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Longcliffe Nursing Home on our website at www.cqc.org.uk.

The home does not have a registered manager in place. 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. A manager was appointed in June 2015 and was in the process of making an application to the Care Quality Commission for registration.

At the last inspection we carried out on 14 and 15 December 2016 we found the provider had not met the regulations relating to the safe care and treatment of people who used the service and good governance. At this inspection we found the provider had made some of the required improvements.

We were concerned that records relating to peoples care were not always fully completed. We saw that records did not show all care that had been given and showed large gaps where people may not have received any care. We found that checks that had been implemented to monitor this after the last inspection had not been continued and the records were still not recording care that people had received.

People were protected from most risks relating to their health and safety. Risks had been assessed and people were now protected from the potential risks of hot radiators and hot water. Radiator covers had been put in place and checks were being carried out on the temperature of the water. We found that risk assessments had been reviewed monthly. However, we found that risks associated with Legionella had not been assessed. Actions that had been identified had not been put in place. Tests that can reduce the risk of Legionella had been carried out but had not been recorded. We found that the provider had not had the water tested for Legionella.

People had most of their needs assessed when they moved to the service. Risk assessments had been completed around the risk of someone falling and control measures were put in place very soon after the person had started to use the service. A checklist had been implemented to make sure that appropriate assessments were completed. However, we found that needs in the case of an evacuation had not been assessed. We also found that people’s care needs had not been fully assessed and they did not have a care plan that told staff how to support the person with all of their identified needs.

We found that where healthcare equipment was used it was being cleaned regularly in line with guidelines for the equipment and this had been recorded.

We found that medicine to be

We inspected Longcliffe Nursing home on 14 and 15 December 2015. This was an unannounced comprehensive inspection. This meant that the staff and provider did not know that we would be visiting.

Longcliffe Nursing Home provides both personal and nursing care for up to 42 people who are aged over 65 and who may also have a physical disability. The home is located on two floors with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 25 people were using the service.

The home does not have a registered manager in place. 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. A manager was appointed in June 2015 and was in the process of making an application to the Care Quality Commission for registration.

At the last inspection we carried out on 29 April 2014 we found the provider had not met the regulations relating to the management of medicines. At this inspection we found the provider had made the required improvements.

People told us that they felt safe and that they enjoyed living at the Longcliffe Nursing Home.

People were not consistently protected from risks relating to their health and safety. Risks had not always been assessed. People were not protected from the risks of potentially dangerously hot radiators and water. Checks in place had not identified the risk of the hot radiators. Checks had identified that the water was very hot but action had not been taken to remedy this.

People received their medicines safely and at the right time. Records contained important information about medicines that people were taking. We found that temperatures were not recorded in the controlled drugs cabinet. Creams and eye drops were not always dated when they had been opened. This meant that there was a risk that important medicines would not be effective and could harm people.

Staff were supported through training to be able to meet the care needs of the people they supported. We found that not all training was in date, and supervisions were not taking place regularly.

Staff told us that they sought people’s consent prior to providing their care. We saw that appropriate assessments had taken place.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity.

People did not always receive the care they needed at the times they wanted it. We saw that staff were not always responsive to people when they asked for support.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

We were concerned that records relating to peoples care were not always fully completed. We saw that records did not record all care that had been given and that there was a risk therefore that staff who did not know people well would not be able to deliver care safely in accordance with their needs.

We found that quality assurance systems were not effective and audits had not been completed when they were scheduled. The provider had not identified the shortfalls in quality that we found during this inspection. This meant that the provider was not able to ensure that people were receiving safe, effective, caring or responsive services that met their needs.

Staff told us that the found the management approachable and felt they were listened to.

We found two breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with five people who used the service, three relatives, five care workers, the registered nurse on duty at the time of our visit and the registered manager. We looked at a number of records including people's personal records, medication records and records kept in relation to the management of the service.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

People told us that they felt safe living at Longcliffe and that they were treated well. One person explained: “I feel very safe here; they look after me very well.” Another person told us: “I’m as safe as I can be; the staff are very good, excellent.”

Risk assessments were in place. Those checked on the day of our visit showed us that the risks associated with people’s care had been appropriately assessed and measures had been put into place to reduce that risk. This showed us that people’s health and welfare was, wherever possible, protected.

Records kept to monitor how much food and drink people had consumed during each day were up to date and repositioning charts (used for people unable to move themselves in bed) showed us that people were being assisted appropriately. This showed us that people were protected from the risk of malnutrition and the development of pressure sores.

Staff spoken with knew what to do if they suspected that someone was being abused. One staff member explained: “I would report it straight the way. “ Another told us: “I would report it to the manager; if they weren’t around I would refer it to the safeguarding authority.”

On checking the medication records we found that on one day, the registered nurse had failed to sign to say that they had dispensed two people’s medicine.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the registered manager understood when an application should be made, and how to submit one. Not all of the staff spoken with were fully knowledgeable in this area

Is the service effective?

We spoke with people who used the service and they all told us that they were satisfied with the care and support they received. One person told us: “I’m very happy here; they come when I ring my bell and that is important.”

Care plans provided staff with information about people’s care and support needs and it was clear from our observations and from speaking with staff, that they understood the needs of the people they supported. One person told us: “The staff are fantastic they know what to do, but always ask first.”

Is the service caring?

We observed staff going about their work in a relaxed and calm manner. They treated the people they were supporting in a kind and respectful way and provided them with the time that they needed in order to carry out a task, whether that was assisting people with their meals or assisting them to the toilet.

Everyone spoken with told us that the staff were caring and attentive. One person told us: “They look after me very well.” A visitor explained: “They are just lovely with them [the people who use the service] very patient.”

Is the service responsive?

People’s needs had been assessed before they moved into the home and they and their relatives had been fully involved in the care planning process. One relative explained: “They talked us through everything, the care plan and the process.”

Relevant professionals had been involved in people’s care and records showed that visits were arranged whenever someone needed to be seen. This included visits from their GP, optician, dentist and the local speech and language team. This ensured that the people who used the service received the care and treatment they required.

Is the service well-led?

Staff had a good understanding of the ethos of the home. They felt supported by the management team and they explained that they were able to talk to the manager if they have a concern of any kind. Staff meetings were also held on a regular basis. This enabled the staff to have a say on how the service was run.

There was an appropriate quality assurance system in place. This enabled the manager to regularly assess the service to ensure that people were receiving the best possible service.

A complaints process was in place and complaints received had been thoroughly investigated. This showed us that complaints were taken seriously and action had been taken where necessary.

During our visit we were able to speak with five people who were using the service. We asked them if they were happy with the care and support they were provided with. They told us they were. One person told us: “The staff are brilliant; you can have a laugh with them.” Another explained: “As a nursing home it is quite passable, the staff are very, very good.”

We were also able to speak with one relative and five members of the staff team. This enabled us to gain their views of the overall service provided. The relative told us: “The staff are great, really friendly, and my relatives face lights up when she sees them.”

We looked at some care plans and found these to be up to date, but other records such as food charts and repositioning charts (used for people unable to move themselves in bed) had not been completed correctly.

When we checked the medication records we found that on three occasions medicines had been given but had not been signed for and one medicine had run out of stock.

At the time of our visit the premises were in the process of being refurbished. A number of areas had already been decorated including the first floor corridor and some of the bedrooms and a refurbishment plan was in place showing the areas to be refurbished in the next 12 months.

Staff told us that they had been appropriately trained and supported and this was confirmed when we checked the training records. One staff member told us: “There is always training going on.”

During our visit we were able to talk to five people using the service, six members of staff and five people who were visiting the service.

Everyone spoken with explained that they were very happy with the care and support they were currently receiving and they told us that the staff were kind and helpful. One person told us, “The staff listen; they are very, very good.”

People told us that they were treated with respect and care and support was provided in a dignified manner. One person told us, “I am very much treated with respect; they are very good in that way.”

People told us that the food served at the service was good and a choice was always offered. One person explained, “The food's alright, it varies, but it can’t be perfect all the time, they can’t please everybody.” Another person told us, "The food is good, there’s a varied menu and you get plenty.”

We were told that people felt safe living at Longcliffe and felt able to speak with the staff should they have any concerns. One person told us, “I would talk to one of the staff or the matron, they’d sort it.” Another person explained, “I have no concerns, but if I did, I’d tell the manager.”

Staff working at Longcliffe told us how much they enjoyed working for the service. One staff member explained, “I love it, it’s nice to help people who can’t help themselves and encourage people who can help themselves to do that little bit more.”

During our visit we were able to speak with four people who were living at the service and two relatives.

People told us that they had been given the opportunity to look around the service before deciding to move in, one person explained, “We looked at three nursing homes and this one seemed the happiest one”.

People told us that they were happy with the care and support that they received at Longcliffe. One person told us, “I am treated very well and we have a very good relationship” (with the staff). Another person explained, “They look after you very well”.

We were told that the food served at the home was good, we were told that meals could be taken in the dining room or in a persons own bedroom and there was always a choice provided. One person explained, “The food’s very good, I’m not a big eater, but I get enough, I’m never hungry”. Another person told us, “The food is lovely, I think it is anyway”.

We were told that people felt safe living there and the staff who provided their care and support did so in a respectful and dignified manner. One person explained, “I feel she is safe, I have full confidence in the staff”. Another person told us, “The staff are lovely, they explain things to you, they couldn’t be better”.