At the last inspection in August 2016, we reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staffing levels and people being left unsupervised.

We carried out an unannounced inspection of Longfield on 26 June 2017 to see if the provider had made the necessary improvements to the service. We saw that improvements had been made to ensure people were kept safe and staffing levels had improved. Safe was rated as 'Good'. The service received a rating of 'Good' overall.

The service provides accommodation with personal care to older people with a range of support needs. These included people with a physical disability and those living with dementia. At the time of the inspection, there were 40 people being supported by the service including two people on short stay visits.

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 service had reviewed their staffing arrangements and made improvements to ensure people were kept safe. There were also systems in place to safeguard people from avoidable harm and staff knew who and how to report any concerns. The risk assessments undertaken provided staff with the necessary information and guidance on how risks to people could be minimised.

The provider had an effective recruitment process in place for the safe employment of staff. People’s medicines were managed safely and given as prescribed.

A very well organised programme of induction, training, supervision and appraisals for staff were in place and they had the knowledge and skills to care for people effectively. They understood their roles and responsibilities to seek people’s consent prior to care being provided.

Systems were in place to ensure that people’s rights were respected and protected under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people did not have capacity to consent to their care or make decisions about their lives, this was managed in line with the requirements of the MCA.

The service had developed new initiative and schemes to share good practice with other organisations which had shown good outcomes for people.

People were supported by kind and caring staff who were respectful and polite to people. They were supported to make choices about how they lived their lives. People's meal time experience was fulfilling and meaningful. They had a balanced diet which was nutritious, home-made and tailored to their individual needs. This helped to maintain their health and wellbeing. People were also supported to access healthcare services when required.

People’s care plans were person centred and provided the necessary information about their assessed needs, preferences and choices. They were involved in reviewing their care plans. People engaged in a range of social and leisure activities both inside the service and in the local community.

The provider had a process in place for dealing with complaints and concerns. They encouraged feedback from people who used the service, their relatives, other professionals and staff, and they acted on the comments received to improve the quality of the service.

The registered manager provided leadership and promoted an open, inclusive and caring culture in the service. Audits and records were completed to assess and monitor the quality of the service. We have made a recommendation that the service considers how to effectively manage the deployment of staff across the service.

We carried out an unannounced inspection on 10 August 2016.

The service provides care and support to older people with a range of support needs including chronic health conditions, physical disabilities, and those living with dementia. At the time of the inspection, there were 34 people being supported by the service and one person was in hospital.

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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from avoidable harm. The provider had effective recruitment processes in place. However, the majority of people, relatives and some staff said that there was not sufficient numbers of staff to support people quickly. People were put at risk of harm when they had been left unsupervised when the only member of staff on each unit supported their colleagues on other units. People’s medicines were managed safely.

Staff had regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. Where people did not have capacity to consent to their care or make decisions about some aspects of their care, this was managed in line with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives. People had adequate food and drinks to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. They were involved in reviewing their care plans. People had been provided with enjoyable activities and some had been supported to pursue their hobbies and interests outside of the home. People were involved in the local community and took pride in their gardens that won a ‘Gold Award’ in a local gardening competition.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service, their relatives, other professionals and staff, and they acted on the comments received to improve the quality of the service.

Various audits were completed to assess and monitor the quality of the service. Staff said that the manager provided stable leadership and effective support, and they also promoted a caring culture within the service. However, they had not taken proactive action to ensure that people were constantly supervised in communal areas of the home.

The provider was not meeting one of the fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

People living in Longfield and their families were happy with the level of care and support offered. People told us, "I have been quite happy with everything," "They are all very very lovely," and, "I have no complaints or concerns." People told us that they could do what they wished and were given choices in their daily lives.

We saw that people's care needs were assessed and planned for with any risks associated with their care being minimised as far as possible.

We found that people lived in a clean and comfortable home. They were protected from the risk of infection as there were good procedures in place and standards of hygiene were well maintained.

Staff said that they were well supported and had opportunities for training. We saw that staff were kept up to date with training in essential areas such as moving and handling. They also had opportunities to undertake training in other areas relevant to their work. Staff felt that communication and teamwork in the service was good. This helped to ensure that people receive a good and consistent service.

People were happy with the quality of the service and there were good systems in place to ensure that the quality and safety of the service was monitored and maintained.

Overall we found Longfield to be a safe, caring, responsive, effective and well led service.

We spoke with six people and two relatives of people who used the service. Some people were not able to communicate with us; however we spoke with those who were able to.

People were treated with dignity and respect and were well cared for. Staff approached people and spoke with them in a kind and friendly manner. People’s expressed wishes including end of life care were met.

We saw that people were provided with care and treatment that met their individual needs. We saw evidence that people had risk assessments completed and that their care plans were reviewed regularly.

We examined the roster for each of the five units in the service for the week of our inspection and found there were enough qualified, skilled and experienced staff to meet people’s needs.

We saw that medication was administered safely and when required. Staff were trained to administer medication and recorded this by signing in the records. Medicines were stored securely.

People were aware of the complaints system in the service. Complaints and compliments information was clearly displayed in the public areas. People were encouraged to feedback about the service.

People with whom we spoke confirmed that they were respected and involved by staff and if they required any assistance staff would respond promptly.

We spoke with a number of people during our visit to Longfield Residential Home. One person told us “It’s nice here. They look after you really well.” We spoke with the relatives of a person living at Longfield who had recently become a resident. They told us “That the staff are lovely. They are very helpful. They have such a good rapport with X. We have nothing but praise for them.” One person we spoke with told us they were happy living at the home and liked their room. They told us “It is a very good home.”

People with whom we spoke confirmed that they were satisfied with the care and treatment provided by staff. They felt able to approach staff if they had any concerns and were confident that these would be addressed appropriately. People told us that they enjoyed being in this service and that the staff were kind. Two people said that they were always doing something interesting.