We carried out this inspection on 30 November and 2 December 2016. Both days of the inspection were unannounced.

The service is registered to provide nursing care for up to 54 older people including people with a diagnosis of dementia. At the time of the inspection 47 people were using the service.

Our last inspection of this service was during December 2015 and we rated the service as requiring improvement overall. This was because we found the provider was not meeting the requirements in relation to safety and providing an effective service. We received an action plan from the service explaining how they would resolve these issues which we used to plan this inspection and check that the improvements had been made. At this inspection we found the provider had taken the necessary action to resolve the issues identified in 2015. However we identified errors with the recording of medicines so we were not assured people always received their medicines as intended. This aspect of the service requires improvement As a result of our inspection the service learnt from this situation and has increased the medicine audits from monthly to weekly and provided additional support to the staff involved

There was a registered manager at the service. 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.

Since our last inspection the manager and deputy manager both new at the time of the previous inspection have established themselves into their management positions. The provider identified the need for additional management support and has appointed a clinical lead nurse. An additional nurse has been rostered on each day time shift so there were two nurses on duty who were supported by team leaders and care staff. The service used a dependency tool to identify the number of staff required to be duty in respect of the needs of the people using the service We found there were adequate staffing for people’s identified needs.

Risks to people’s safety were adequately managed. The service assessed people’s risks of falls and monitored any falls that people sustained to identify any triggers and put additional safety measures in place. Staff had received training in managing risk and how to provide a safe environment for people. Regular environmental check were in place.

Staff received training in safeguarding and were aware of what actions they should take to safeguard people from potential, actual abuse and knew what actions to take to promote people’s safety and well being.

There was a robust staff recruitment policy and procedure in operation. This helped to ensure only suitable staff were employed. Once employed staff were supported by an induction and regular supervision was provided by the senior staff. Training was provided to develop and maintain staff skills including the nursing staff who were all working upon revalidating their qualification.. All nurses are required to do this by their governing body the Nursing and Midwifery Council, (NMC) The management team were supported by regular visits from the provider. The provider had also enlisted the support of Consultant to provide training to all staff and work with the management team for the smooth running of the service.

There were suitable arrangements for the safe storage, management and disposal of medicines. However we did identify two recording errors of people’s medicine which we brought to the attention of the deputy manager.

The senior staff of the service were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had made referrals and worked with the Local authority to support people who used the service with regard

During our inspection we spoke with three people who used the service. We talked with two domestic staff, a cook and three members of the care team. We spoke with three relatives. We also spoke with the training coordinator and a visiting chiropodist. The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

Staff had received a range of training to protect people from harm. Safeguarding of vulnerable adults from abuse (SOVA), Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) training were completed every year. Staff we spoke with told us that they were aware of the action they would take if they suspected abuse was or had taken place. They were also aware of what it meant to deprive someone of their liberty and why this was sometimes necessary.

We found that the service had arrangements in place to gain people's consent and assess people's mental capacity to make decisions should they not be able to consent to their care.

The policy, procedures and quality monitoring of the service included health and safety and reviews of care planning and delivery. This system was comprehensive and ensured people lived in a safe environment with safe care.

Is the service effective?

People were satisfied with the care and support they received. This was consistent with the positive feedback received from people as reported in the provider's quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, “One person said, "They (the staff) are lovely." Another said, "I do feel that they look after me well." A relative said, "We looked at other homes but when we came here, we had such a lovely warm welcome. It's been the same ever since."

We observed the care and attention people received from staff. All interactions we saw were appropriate, respectful and friendly and there was a relaxed atmosphere throughout the home.

Is the service responsive?

We saw that care plans and risk assessments were up to date and regularly reviewed. The registered manager responded in an open, thorough and timely manner to complaints. This meant that people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was professional and supportive.

Is the service well led?

A comprehensive quality monitoring process and improvement plan was in place. Regular care reviews and discussions about nursing, care and social needs with people who used the service and their families took place. This ensured that people's changing needs and preferences were always taken into account. Staff training and supervision was provided for all staff. They told us they felt supported in their role.

Where people were unable to speak with us we observed, positive support from staff and people were relaxed. One relative told us the home was: “Very welcoming.” and that: “There are always plenty of staff.” Another relative told us: “I feel happy when I go home and leave X as I know they are looking after them.”

Care had been planned and was person centred. One relative told us: "They don't just look after X they look after me too. Bit like a family." People were asked for their consent before they received any care or treatment. We observed staff supporting people to attend to their needs in a warm and friendly manner, affording dignity and respect.

Meals were well presented and individual to people’s needs. One person told us: “The food is lovely.” One relative told us: “I often taste the food when I am helping X to eat and it’s always very tasty.”

People living at Longmead Court Nursing Home benefitted from a comfortable, well maintained environment.

There were recruitment processes in place to ensure newly appointed staff were suitable to fulfil their role.

There were systems in place to ensure people’s comments and complaints were listened to and acted on appropriately.

We used a number of different methods to help us understand the experiences of people using the service. This was because most of the people using the service had complex needs which meant they were not able to tell us their experiences.

People who were able to speak with us told us that they enjoyed the activities provided. One person said that they especially enjoyed the church services. One person told us "This is my home and I am happy here." Two members of staff told us that they were provided with all the necessary training and support that enabled them to look after people appropriately.

We were told by two relatives that they considered the care and support provided to people living at Longmead Court was “Very good.” One relative said that the manager's door was always open in order to raise any questions or concerns directly with them. One relative told us "The manager and staff are exceptionally kind and caring and nothing is too much trouble for them."

Some of the people who use this service have difficulty understanding and responding to verbal communication. During our visit on 04 November 2011 we were able to hold a conversation with two residents. Most of the information we obtained during our visit to Longmead Court Nursing Home was gathered through our observations.

One person living at Longmead Court Nursing Home told us “You’re looked after here. They do look after you and they listen to you.” A relative that we spoke with told us that the staff were very friendly and helpful and always come to check if everything is alright. ”They also said, “We have no concerns with the care. X has settled in here. “Another person told us that they found the home very good and said that their loved one’s personal care needs were met. “X likes it here. They are very respectful to X.”

This inspection took place on 9 and 16 December 2015 and was unannounced. The last inspection of this service took place on 5 June 2014 when no breaches of regulations were found.

Longmead Court Nursing Home provides care and accommodation for up to 54 older people including people living with dementia. There were 47 people receiving care at the time of our inspection.

There was not a registered manager in place. The recently appointed manager is seeking registration. 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 who used the service had not felt safe in the past but his had improved particularly with the increase of nursing staff from one to two being on duty. People living at the service, staff and visitors described the new management of the service as open and approachable. All staff were now receiving supervision.

New staff to the service had not received induction training in particular training with whistle-blowing and safeguarding. The service was addressing this issue as well as providing training for staff regarding Parkinson’s disease. This was important as some people using the service had this diagnosis. Some risk assessments were not in place to specific needs regarding actions to take in the event of choking. Nutrition records were not accurate but again this was being addressed at the time of our inspection.

People had their mental health needs monitored. The senior staff of the service were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had made referrals and worked with the Local authority to support people who used the service with regard to (MCA) and (DoLS).

Considerable work had taken place in the reviewing and writing of care plans so they were person-centred. The manager had also arranged with a GP for all peoples health needs to be reviewed which had resulted in some major changes to people’s medication. Medicines were administered safely and since the increase in staffing medicines audits were now in place.

Relatives and people who used the service were consulted about the way in which the service should provide activities for people. The views of the meals were mixed but people thought there was sufficient food and choice.

Before moving to the service an assessment of people’s needs was carried out from which a care plan was written and reviewed regularly.

Staff had worked with people to support them to access and be visited by healthcare professionals, including mental health staff with specific knowledge in the care for people with challenging dementia needs. Four people in the service were receiving dedicated 1:1 care and had their individualised needs met.

Relatives and people told us that they were confident in the manager and senior staff who they saw regularly.

There was a statement of purpose and an on-call service in place to support staff.

We found a breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.