Longlea Nursing Home is registered to provide accommodation and nursing care for up to 22 people. During our inspection there were 19 people using the service.

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 and associated Regulations about how the service is run.

We previously inspected the service on the 19 and 20 May 2016. Following our visit the service received an overall rating of ‘requires improvement’ with a rating of ‘good’ in the key question is the service caring. We found there were no records to show what actions had been taken by the service when people had sustained unwitnessed injuries. The service’s safeguarding policy was not updated and did not provide staff with the necessary information to handle suspected abuse or unwitnessed injuries. The service did not ensure there were sufficient staff to provide care and support to people at night time. The service did not have sufficient suitably qualified, skilled and experienced staff to meet people’s care needs in the absence of the registered manager. There was no structured support for new staff that required additional help whilst undertaking the induction programme and people’s social needs were not always being met. After our visit we asked the provider to complete an action plan with a date when they would be compliant. The provider submitted the action plan by the required timescale and informed us improvements would be made by November 2016.

During this visit we found the service had made improvements in all areas previously identified.

People received safe care, treatment and support from staff who were aware of their safeguarding responsibilities. Appropriate action was taken when unexplained injuries occurred and there were sufficient staff to provide care for people during the day and at night. Medicines were administered and handled safely.

People received care from staff who were appropriately inducted, supervised and appraised. The service sought consent from people in line with current guidance and legislation. People were supported to have a well-balanced diet and had access to health services and on-going health care support in order to maintain good health.

Positive caring relationships were formed between staff and people who used the service. People expressed their views and were involved in making decisions about their care. People’s privacy and dignity was respected and promoted. The service sought people’s wishes and preferences in regards to end of life care.

People received personalised care that was responsive to their needs. The service responded to people’s social well-being in order to prevent them from being isolated. People and relatives knew how to raise concerns and felt they could confidently do this if they needed to. We have made a recommendation for the service to ensure all relevant external agencies contact details are placed in their complaints policy and ‘resident’s guide’.

People who used the service, relatives and staff felt the service was open and inclusive. Comments received included, “Management are very good and approachable” and “They (management) are most definitely supportive. They are approachable, we have no closed doors.” People received care from a service that ensured its staff members’ supervision and leadership were met. The service acted upon feedback received to improve on the quality of the service provided. Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home.

Longlea Nursing Home is registered to provide accommodation and nursing care for up to 22 people. During our inspection there were 20 people using the service.

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 and associated Regulations about how the service is run.

We previously inspected the service on the 16 August 2014. The service received an overall rating of ‘requires improvement’. We rated the service good in the domains of ‘responsive’ and well-led. However, we had concerns with the service’s recruitment processes. Staff training was not up to date and people’s confidential information was not protected.

During this visit we found the service had addressed all the concerns found at our last inspection. However, we found there were aspects of the service’s practice that placed people at potential risk of harm. For instance, staff were knowledgeable about the signs of abuse and what would constitute a safeguarding concern and attributed this to the training. However we noted there were no records of actions taken by the service when people sustained unwitnessed injuries. The service’s safeguarding policy was not updated and did not give staff up to date guidance on how to handle suspected abuse and what to do when unexplained injuries were found. We made a recommendation for the service to seek guidance on how to complete body maps, when people sustained unexplained injuries.

The service did not ensure there were sufficient staffing levels to meet people’s care and support needs at night time.

There was no structured support was in place for new staff who required additional help when undertaking the service’s induction program. We made a recommendation for the service to seek current guidance on how to provide additional support to new staff that require it.

People’s social needs were not always being met. Staff did not have enough time due to work pressures, to organise meaningful activities and people’s desire to go out on day trips was not realised because the service’s minibus was being used by the maintenance team. This meant people’s well-being was negatively affected because meaningful activities in the service were limited and was not always person centred. We have made a recommendation for the service to seek current guidance on meaningful activities that promotes people’s health and well-being.

The registered manager did not receive appropriate supervisory support and there was no contingency plan was in place in the event the registered manager was not able to work. The provider did not consistently act on the feedback given by people who used the service. Policies and procedure were not always reviewed and kept up to date. This meant there was a potential for people to receive unsafe care. The service did not analysis trends or triggers when accidents occurred.

People and relatives described staff as kind, caring, considerate and patient. People said staff treated them with respect and protected their dignity. Staff demonstrated a good understanding of people’s care needs; family histories and preferences. People and their relatives said they were involved in decisions about their care. People’s preferences and choices for their end of life care were clearly recorded, communicated and kept under review.

People, their relatives and staff felt the service was well led due to the leadership of the registered manager. Staff felt supported in the job roles and was aware of how to report any poor work practices or concerns. The service carried out regular audits to improve the quality and the safety of the service.

People and their relatives felt the service ensured they were kept safe from abuse. Care records contained individual risk ass

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

A registered manager was employed by this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law as does the provider.

Longlea Nursing Home provides a service for up to 22 older people. People may need care for a period of time to recover from illness or have lived in the home on a longer term arrangement. At the time of our inspection 19 people were using the service. This was an unannounced inspection.

We looked at the provider’s recruitment processes. It is the legal requirement for the provider to obtain satisfactory evidence of conduct in previous employment relating to health or social care, or children or vulnerable adults. In one out of four staff files we looked at, one reference was missing relating to staff’s conduct in such previous employment.

There was no clear and safe system of checking expiry dates for all of the medicines to make sure they were safe to give to people. Although medicines were kept securely, there was a risk of people being administered out of date medicines which may affect their health and wellbeing.

Staff did not always share people’s personal information in a confidential way. We did not see any agreement from people indicating they consented to their personal information being shared in the home in front of other people or visitors.

Staff had not completed recent training in dementia care, fire, food hygiene and health and safety. There was a risk of people being supported by staff who may not have up to date knowledge and skills. However, staff were supported appropriately to understand and carry out their roles and responsibilities by appropriate supervisions and appraisals, team meetings and handovers, and daily communications with senior staff and the registered manager. The provider ensured there were enough staff to meet people’s needs.

People and their relatives felt safe at Longlea Nursing Home and they were protected from abuse. Staff knew how to identify if people were at risk of abuse and knew what to do to ensure they were protected. The registered manager was knowledgeable about Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA) and had taken the right action to ensure people’s rights and liberties were protected.

Throughout our inspection we saw examples of appropriate support that helped make the home a place where people felt included and consulted. People and their relatives were encouraged to plan their own care and support. We saw staff responded to people’s needs quickly and in a caring way. People said they were treated with dignity, privacy and respect.

People were supported to maintain their health and wellbeing because staff knew the people well. There was enough food and drink available and we saw the mealtime was enjoyable time for people. People were supported to choose food and to eat their meal without being rushed. Staff treated people in a caring way.

Systems were in place to identify, report and respond to incidents and accidents appropriately and action was taken to prevent these events from re-occurring. The registered manager assessed and monitored the quality of care. The home encouraged feedback from people and their relatives, which they used to make improvements to the service.

In July 2013 the provider Longlea Limited became the registered provider for Longlea Nursing Home. We had previously inspected Longlea Nursing Home under a previous provider in May 2013 and had found some areas of non-compliance. As part of their registration assessment, we requested that Longlea Limited send us confirmation that the concerns identified in May 2013 had been addressed for outcome 2, outcome 7 and outcome 9.

Prior to this inspection Longlea Limited had provided us with information on the actions they had taken to ensure compliance in these areas.

We spoke with three people who use the service, and three relatives of other people who use the service. One relative told us “I can’t fault the staff.” Another relative said “Staff are very kind. They take time to talk to people.” One care worker told us “Staff and residents develop relationships. It’s like a home from home here.”

The provider had suitable arrangements in place to obtain and act in accordance with people’s consent for care provision. They understood the decisions people were able to make for themselves, and who to consult legally to make best interest decisions when necessary. One care worker told us “We have a discussion. People have the right to refuse. We also discuss it with relatives, as they may be able to understand them better if there is a communication difficulty. If there’s risk involved, we look at options and take best interest decisions.”

Care workers were aware of the actions to take if they were concerned people were at risk of harm. Appropriate measures were taken and recorded if people who use the service had their liberty restricted, for example through the use of bed rails to ensure they were kept safe from falls overnight.

Medications were managed safely. Appropriate storage facilities were available, and nurses who administered medications recorded these from arrival at the home to dispensing or disposal. The manager carried out regular audit checks to ensure medications were appropriately managed.