Longlands Care 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. The service provides personal care to a maximum of 43 older people and/or older people living with a dementia. At the time of the inspection there were 39 people who used the service.

We last inspected Longlands Care Home in January 2017 when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to good governance and staffing.

At our last inspection, the service was rated 'Requires Improvement'. Following the inspection we asked the provider to complete an action plan to show what they would do and by when to improve all five key questions to at least Good. At this inspection on 7 March 2018 we found there had been improvement in some areas, but limited improvement in others. This is therefore the second consecutive time the service has been rated Requires Improvement.

The home 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.

There continued to be shortfalls in the service that were identified at the last inspection. The oversight of the service by the provider had not improved. The provider visited the service regularly and this was confirmed by the registered manager and staff. However, quality monitoring was ineffective as it did not identify the concerns that we found at inspection.

Since the last inspection the audit tool had been developed to include prompts and pointers for discussion, however, the provider had not identified that fire drills were not happening regularly and not all staff had taken part. The audit had not picked up that numerous emergency lights were not working from April 2016 until September 2017. In addition they failed to identify that care records were insufficiently detailed and mental capacity assessments and best interests had not been completed.

During the inspection we looked at some bedrooms, toilets, shower rooms and communal areas to check the environment was clean and staff followed safe infection control practices. In one bedroom we found a worn divan bed and dirty toilet and in another room a soiled mattress. We asked the registered manager to undertake a check of all beds and mattresses within the service to make sure they were clean and fit for use. After the inspection they sent us a report of their findings and mattresses that were to be replaced.

During the walk round we identified a number of rooms requiring refurbishment and redecoration. The registered manager sent us their refurbishment plan for 2018 which highlighted that these areas would be part of the plan.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place.

Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place.

Most people and relatives told us there were suitable numbers of staff on duty to ensure people’s needs were met. Pre-employment checks were made to reduce the likelihood of employing people who were unsuitable to work with people.

The registered manager had systems in place for reporting, recording, and monitoring significant events, incidents and accidents. The registered manager told us that lessons were learnt when they reviewed all accidents and incidents to determine any themes or trends.

People were supported by a regular team of staff who were knowledg

We inspected Longlands Care Home on 11 January 2017. This was an unannounced inspection, which meant that the staff and registered provider did not know we would be visiting. When we last inspected the service in October 2014 we found that the registered provider was meeting the legal requirements in the areas that we looked at and rated the service as good.

The home 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.

Longlands Care Home provides care an accommodation for up to 43 older people and / or older people living with a dementia. At the time of the inspection there were 38 people who used the service.

The registered provider visited the service and completed an audit to check the service was safe, effective, caring, responsive and well led. However, audits were ineffective as they did not pick up on areas that we identified as needing improvement at this inspection. In their visit in June 2016 they identified that PAT testing was out of date and again in December 2016, however this testing was not completed until after our inspection in January 2017. We noted that there wasn’t a system to ensure all areas of the audit were covered. The audit had a section to check on risk assessments for people who used the service yet it was noted that in audits undertaken in June, September and December 2016 risk assessments were not looked at despite us mentioning this at the previous inspection and at an inspection of another home in the organisation.

Risk assessments were insufficiently detailed. They did not contain individual person specific actions to reduce or prevent the highlighted risk. This meant that safety actions to keep people safe were not documented and people could come to harm.

Records of staff supervision did not indicate that it was individual to the person and covered areas such as their performance, training needs or any personal discussions.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff had an understanding of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. This meant they were working within the law to support people who may lack capacity to make their own decisions. However, further work was required on some care plans to ensure that decision specific capacity assessments and best interest decisions were completed.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People told us that staff treated them well and they were happy with the care and service they received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People were treated with kindness and respect. The care staff

During the inspection we spoke with five people who used the service and one relative. We also spoke with the manager, deputy manger and two of the care staff on duty.

We observed the experiences of people who used the service. We saw that staff interacted and communicated well with people. The staff were attentive and demonstrated knowledge and understanding of people’s needs.

The people we spoke with told us they were happy with care they receive. People told us they were involved in their care planning and able to make their own choices.

One person told us, “I am happy, the staff look after me very well.” Another person said, “The staff are wonderful even if they are busy and you stop them they are always nice.” A relative we spoke with told us, “I viewed this place before my relative came in. I chose here and I am very happy.”

We saw that people had their needs assessed and that care plans were in place.

We found that people were safeguarded against the risk of abuse.

We found that appropriate staffing was in place to deliver people’s care.

We found that systems were in place to monitor the quality of the service.

The visit took place because we were following up concerns raised at the last inspection about how people were supported to make choices; how staff administered medication; staff training; and the maintenance of the building. Therefore when talking with people we concentrated on these specific areas. We spoke to ten people who used the service and one relative. People said "The staff are really helpful and treat me well'', ''It is nice, if I didn't like I wouldn't keep coming back and this is my third time here'', ''I find the staff know what I need and do make sure I get everything" and ''They go out of their way to make sure you are okay''. Relatives told us ''I find the staff are good and seem to know how to care for the people here.''

People told us that they were very pleased with the service and found the care was good. Some people would have preferred to be at home but said that this was nothing to do with the care being provided just their desire to be at home. Throughout the inspection we observed staff practices and saw that they constantly took the time to talk to people, engaged individuals in activities and in a sensitive manner explained to a person how they were going to help people meet their care needs. Throughout we found that staff treated people with respect.

During our visit to Longlands Care Home, we spoke with five people who use the service and two relatives.

One person told us that “I like living here. I could live with my daughters, but I prefer to live here. The staff are all lovely, and that’s half the battle.”

Another person told us that “One of the problems here is that staff don’t spend much time talking to you when they come to answer the buzzer. As soon as they have finished they are off doing something else. I like to chat and they don’t seem to have the time”. They also told us “The lift being broken has been a problem. I have missed medical appointments, as I can’t get downstairs”.

Over lunch, people told us “There are things such as bingo going on, if you like that type of thing”.

We spoke with a family member who told us “It’s smashing here, my mother seems happy here. I can visit whenever I want. There are lots of activities going on. There is a Halloween party happening this Friday”.

We inspected Longlands Care Home on 15 and 16 October 2014.  This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. 

Longlands Care Home is a residential care home providing personal care for up to 43 people and / or people living with a dementia.  At the time of the inspection there were 40 people who used the service.  Accommodation is provided over two floors and includes communal lounge and dining areas. Externally there are garden areas and a car park.

The home had 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.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.  Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

We found that people were encouraged and supported to take responsible risks.  People were encouraged and enabled to take control of their lives. 

We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff.  Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. 

There were positive interactions between people and staff.  We saw that staff were kind and respectful.  Staff were aware of how to respect people’s privacy and dignity.  It was evident staff knew people who they supported and cared for well.  People and relatives told us that they were happy with the care and service provided.  People told us that they were able to make their own choices and decisions and that staff respected these.

The registered manager and staff had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).  The registered manager understood when an application should be made, and how to submit one. This meant that people were safeguarded and their human rights respected.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.  People told us that they liked the food provided.

People were supported to maintain good health and had access to healthcare professionals and services.  People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments. 

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information and set out how each person should be supported to ensure their needs were met. We found that risk assessments were insufficiently detailed.  They did not contain individual person specific actions to reduce or prevent the highlighted risk.  This meant that safety actions to keep people safe were not documented and people could come to harm.

We saw that people were involved in a wide range of activities.  We saw that staff engaged and interacted positively with people.  We saw that people were encouraged and supported to take part in activities.  

Appropriate systems were in place for the management of complaints.  People and relatives told us that the registered manager was approachable.  People we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided.  Staff told us that the home had an open, inclusive and positive culture.