Longmead House

Updated 1 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Longmead House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Longmead House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

The provider is registered as an individual and as such is not required to have a registered manager in place. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who used the service and 1 visitor about their experience of the care provided. We spoke with 6 members of staff including the owner. We also spoke with the consultant/trainer involved the running of the home.

We reviewed a range of records. This included 5 people’s care records and the medicines records for all the people using the service. We looked at 5 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including incidents and accidents records, audits and safety checks. Policies and procedures were reviewed. After the inspection, we continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We contacted 3 professionals who regularly visit the service and received a reply from 1.

Updated 1 September 2023

About the service

Longmead House is a care home providing personal care and support for a maximum of 23 people. Accommodation is set over three floors all of which have access via stairs or a lift. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 15 people using the service.

People’s experience of using this service and what we found

Risk assessments and support plans were not always in place to help staff to deliver safe care to people. Some risks had not been identified, managed and mitigated. We witnessed an unsafe moving and handling practice which put a person at risk of avoidable harm. People did not always receive their medicines safely and as prescribed.

Incidents and accidents were not always recorded appropriately, analysed or reviewed. There was no evidence lessons were learned from incidents and accidents.

People were not always protected from the risk of infection and cross contamination. On the day of our inspection, there was a malodour which persisted throughout the day. Furthermore, most areas of the home were dusty and unclean.

Although there was a fire assessment in place and records of fire safety checks, a person’s fire door was being propped open by an object. This put the person at risk of harm, should there be a fire.

Recruitment checks were not always carried out. One staff member’s file did not contain the necessary documents to help ensure they were fit to deliver care to people. There were no regular staff meetings or meetings for people who used the service.

People were not always treated in a kind and dignified manner. Some practices were task-centred and did not recognise people’s individual needs.

There were few activities taking place on the day of our inspection, and the activities on offer did not meet people’s needs. People told us they were bored. The environment and the activities had not been developed to meet the needs of people living with dementia.

Care plans were developed from the initial assessments and contained information for staff to know how to meet people’s needs. However, these had not been reviewed for several months. This meant we could not be sure people’s current needs were met.

The provider’s quality monitoring systems were infrequent and had failed to identify the shortfalls we found during our inspection. The provider had not carried out regular audits and checks of the service for several months. The service failed to demonstrate they were providing care and support that was safe, caring or responsive. This put people at risk of harm.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Rating at last inspection

The last rating for this service was good (published 6 June 2018). At this inspection the rating had changed to inadequate.

Why we inspected

The inspection was prompted in part due to a safeguarding concern. A decision was made for us to inspect and examine this risk. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, fit and proper person employed, person-centred care and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.