Longmore Nursing Home provides accommodation and personal care for up to 20 older people. Nursing care is provided and this includes a small number of people living with dementia. At the time of our visit 20 people lived at the home.

The inspection took place on 11 January 2017 and was unannounced. The service was last inspected on 12 November 2015 when we found some improvements in relation to the quality and safety of the service were required.

A registered manager had been in post for over 12 months. 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 the home and we saw enough staff were on duty to keep people safe and meet their needs. Since the last inspection new staff had been recruited and changes had been made to ensure people received consistent care. People spoke positively about the support they received from the consistent staff team.

The provider's recruitment procedures minimised the risk to people's safety of unsuitable staff being employed. Staff understood their responsibilities to protect people from harm and felt confident to raise any concerns. Risk assessments and management plans were in place to minimise the risks to people's safety. Staff knew people well and clear guidance was in place for staff to follow to manage the identified risks. Our discussions with staff demonstrated a consistent approach to the management of risks.

People received their medicines as prescribed. Medicines were administered safely by qualified nurses. However, the storage of some medicines required improvement.

Since the last inspection staff had completed further training to support them carry out their roles safely and effectively. New staff received an induction prior to working unsupervised and staff received training in health and social care to develop their skills further.

Since our last inspection the home manager had increased their knowledge in relation to the Mental Capacity Act (2005). They understood their responsibility to comply with these requirements. Since the last inspection ‘decision specific’ capacity assessments had been completed for those people who lacked capacity, so suitable decisions could be made in their best interests. The correct action had been taken for restrictions in people's care to be authorised. Staff understood their responsibility to seek people's consent before they delivered care.

People enjoyed the varied social activities that were available. Mealtime experiences were enjoyable for people and they received a varied and nutritious diet. Where necessary, specialist diets were catered for and people were supported to eat. Staff demonstrated a good understanding of people's nutritional needs. The staff team worked closely with external healthcare professionals to ensure people's health and wellbeing was promoted and maintained.

There had been significant improvements to the systems in place to monitor the quality of the service provided since our last inspection. Analysis of incidents and accidents took place to identify any patterns or trends to reduce the likelihood of further incidents occurring. People were more involved in planning their care since the last inspection and care plans contained more detailed information about people. This meant care was provided in a personalised way.

People told us care workers showed them kindness and they had the correct skills and experience to provide the care and support they required. People received care from staff who were respectful and ensured people's privacy and dignity was maintained. Relatives and visitors were welcomed at the home and were encouraged to be actively involved in people's lives.

People

This inspection took place on 12 November 2015 and was unannounced.

Longmore Nursing Home provides care and accommodation for up to 22 older people. There were 21 people living at the home at the time of our inspection. Nursing care is provided and this includes a small number of people living with dementia.

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 time of the inspection the registered manager had recently left their employment at the home and a new manager was in post.

Staff were available at the times people needed them, however frequent changes in staff did not always ensure continuity of care. There were a number of staff vacancies and plans were in place to address this. The number of staff on duty had increased recently and staff vacancies were covered by agency staff until the time that new staff were recruited. Staff had received training so that, overall people’s care and support needs were met. Further staff training was planned.

Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks.

People were involved in decisions about their care and told us that they received support in the ways they preferred. People were happy with how their personal care needs were being met and told us that staff encouraged them to remain as independent as possible. Group social activities were arranged, however people had limited opportunities to pursue their individual hobbies and interests. Plans were in place to address this. People were supported to maintain relationships with people important to them and visitors were welcomed at the home.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. However, ineffective communication between the staff team had resulted in a delay in some people receiving dental care and treatment. Medicines were managed so that people received their medication as prescribed, however improvements were needed in relation to the recording and disposal of medicines.

Staff understood the principles of the Mental Capacity Act (MCA), and care workers gained people’s consent before they provided personal care. The manager told us that as they were new at the home they would liaise with the Local Authority in order to discuss the MCA further.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. This was through regular communication with people and staff and a programme of other checks and audits. Due to the recent management changes at the home quality monitoring had lapsed recently, however plans were in place to address this. The management team ensured actions were taken following suggestions put forward, for the benefit of people who lived at the home.

Longmore Nursing Home provides nursing care for up to 22 people. A registered manager was in post. At the time of our inspection 19 people used the service and the home consisted of a lounge and conservatory on the ground floor. Bedrooms were located on the ground and first floor which could be accessed by a lift.

On the day of the inspection we saw people appeared to be well cared for by staff who were kind and compassionate. People told us staff were, "Always there to listen" and "The staff respect individual needs". Staff knew how to keep people safe and recognised risks posed to people's health and well-being. They understood people's needs and care records contained information they required to provide care and support based upon people's individual preferences.

People told us they felt safe. We saw that staff understood the risks surrounding people’s health and well-being. We saw there was a process in place which ensured risk assessments were kept up-to-date.

An effective management of medicines system was in place and people were protected by systems that ensured they had the correct medicine at the time it was prescribed for.

Equipment used at the service was in good working order and had been checked at the required frequency. This meant people could be confident they could access safe equipment.

The registered manager was well respected by people who lived at the home. Staff felt supported by them and any concerns they had were acted on.

Quality monitoring of the service was carried out regularly by the owners and the registered manager in order to assess the standard of care provided and implement any changes required. This ensured the service was able to respond quickly to any issues that arose.

We found the service to the be meeting the requirements of the Deprivation of Liberty safeguards. People's human rights were therefore properly recognised, respected and promoted.

We carried out a routine inspection at Longmore Nursing Home on 2 December 2013. We looked at how people were involved and treated at each stage of their care. We looked at how medication was managed by staff. We looked at equipment used by people who used the service and we looked at staffing levels and training for staff. We talked with people who used the service, their relatives and staff.

We observed staff generally interacting with people with kindness. However we saw some people were not always treated with dignity.

We saw some people’s risk assessments and care plans did not always reflect their needs.

We saw most people were supported with safe management of medicines. However not all medicine charts were completed accurately and one medication was stored below the recommended safe temperature level.

We saw most of the equipment provided was safe for people to use, however during our inspection we saw several items of equipment were out of order.

We spoke to three people who used the service. They told us they were happy with their care. One person stated, “The carers are warm and friendly and nothing is too much trouble.”

When we inspected this service in September 2011 we found that improvements were needed.

We undertook this inspection to check if the provider had improved the service they provide.

We made an unannounced visit to this care home on Thursday 31 May 2012.

We spoke with seven of the 20 people using the service at the time of our inspection and one of their relatives. People spoken with told us they were satisfied with the care they received. Their comments included,

“Staff behave beautifully. They are kind and polite and do what I need.”

Some people using the service had complex care needs, which meant they might have difficulty talking to us about their experiences. We spent time in the lounge closely observing people’s experience. We looked at their mood, how they spent their time and how staff interacted with them.

We saw some sensitive staff interactions with people using the service. For example, we observed that most staff bent down to people sitting in chairs to speak with them face to face at their level. We observed some staff spending time talking with people at a pace and level appropriate for the person.

We observed staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs.

People that were being cared for in bed had been made as comfortable as possible with pillows, blankets and call bells close to hand.

It was evident from our observations that people had received the support they needed to maintain their personal appearance and hygiene. People looked groomed and appropriately dressed. We noticed that people’s skin and fingernails were clean.

We spoke with the registered manager, the deputy manager, a nurse and two care staff. We looked at some records relating to the running of the home, such as the staff duty rota and training records.

Overall, we found that the provider had made the improvements necessary to meet the compliance actions we issued following the last inspection.

We spoke to five people's relatives and friends as most people in the home had dementia and could not tell us their experience of the home. We also observed how people's care was given. We spoke to three of the staff.

People's relatives and friends told us that they were happy with the care that people received. They said Longmore Nursing Home was: "Homely," "Beautiful" and "Like a big family."

We were told before we visited that sometimes information was not kept as confidential as it should be, people sometimes had to wait if they needed the toilet and there had been problems with the hoists.

People's relatives were happy with the health services were arranged when they needed to be. For example people had a chance to see their GP every week. They said people were well groomed and their personal care needs were attended to. People "loved" the food. People's relatives were able to assist them to eat and felt welcome when they visited.

People said that the care workers were approachable and helpful.