18 July 2023
During an inspection looking at part of 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.