Longview

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. Systems and processes were in place to keep people safe however, risks associated with people's care needs had not always been assessed. Information relating to people's individual risks was not always recorded, up-to-date or did not provide enough assurance that people were safe. Safeguarding policies and procedures were not always followed when safeguarding incidents had occurred. Staff told us they received an induction when they started work. However, there was no written evidence of a completed induction on some staff files. The service had safe systems for appropriate and safe handling of medicines. However, these were not always being followed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management had been engaging with the local authority to make improvements at the service to support better outcomes for people. Management had weekly visits from the local authority who had helped to facilitate learning and improvements at the service. The manager cascaded learning to staff during flash meetings which took place every morning. However, some staff felt that concerns were not always shared appropriately, and some staff did not always feel involved with changes being made to the service. There were systems in place to record incidents and accidents which were reported by staff but these often-lacked information and detail. The manager reviewed incidents to identify where actions where needed but care plans and risk assessments were not always updated accordingly.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the service. One person told us, “I feel safe living here and if I had any problems, I would tell staff and they would regularly check up on me.” However, another person told us, “One or two of the staff members have been a bit sharp with me, it is the pressure they are under, I do understand that they have got some difficult patients”. A relative told us, “[Relative] has been here for 6 months. We had a few concerns regarding staff, there were less than we would have liked but things have been improving over the last couple of months.”

Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people including informing other agencies if they were concerned about action being taken. However, as per the service’s training matrix, not all staff had completed their safeguarding training. A staff member told us, “I would report to my manager, and I would escalate to Local authority if I needed to”. However, some staff told us, “I don’t always feel confident or comfortable if I witnessed an incident between the residents. We haven’t had any training on how to intervene so I would find it hard to get diffuse the situation.”

During the inspection, we observed staff responded to support people promptly. Staff supported people to move safely using assessed equipment where required.

Safeguarding policies and procedures were in place however, these were not always followed when safeguarding incidents had occurred. Not all safeguarding allegations had been referred to the appropriate authorities in a timely manner. Limited information was being recorded in the investigation reports. Accident and incidents were documented but there was little evidence the service used this information to learn from and prevent a similar accident or incident from occurring in the future. Feedback from a health professional stated, “safeguards are not consistently being raised and on occasions, referrals being made have information seemingly copied pasted leading to inaccurate information.” The lack of robust systems and processes to safeguard people from abuse was a breach of Regulation 13 (Safeguarding people from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Relatives told us that they did not always feel involved in their relatives’ care. Not all relatives had seen or been involved in writing their relatives care plan. Relatives were not always informed about accidents and incidents in a timely manner. Relatives told us they had not been invited to attend reviews.

Staff had a good understanding of people's risks and how to safely support them. However, changes to people’s care needs were not always identified and referred appropriately. Staff had not received training on positive behavioural support. This training supports people and involves understanding the reasons behind their behaviours.

Throughout the assessment, we observed people being supported to move using mobility equipment and this was done safely. A person was using a Zimmer frame to enter the dining room and staff supported them and were responsive to any potential risks. However, our assessment found elements of involving people to manage risks did not always meet the expected standards.

Although there was limited impact for people using the service, not all risks to people's safety and wellbeing were assessed, recorded or provided enough detail as to how identified risks should be managed and mitigated. For example, people who had a daily fluid intake target did not always have their daily targets met. This placed people at potential risk of not having risks to their safety met in an appropriate and safe way. People's care plans and risk assessments were not always personalised, and support was not always in line with people's care plan guidance. Improvements were required to ensure completed care plans and risk assessments were person centred and included how risks to people were to be mitigated and reduced. Some information was generic and not personalised to the individual people using the service. A health professional told us, “Risk assessments and care plans are not being updated consistently and information does not always triangulate or on occasions is inaccurate.” Systems had not been established to ensure care and treatment was provided in a safe way for service users. This placed people at risk of harm. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff told us they felt the environment was safe. However, a member of staff told us, “We need a bigger dining room lounge or a separate dining room. People should not be sitting on these same hard chairs from breakfast to when they are ready to go to bed whenever they choose. I have told management this from when I started here, I knew of the problems they had before I accepted the job”.

Generally, the environment was well maintained, and staff had access to the equipment they needed to support people safely. However, we found flooring in one room needed replacing. The manager told us they had plans in place for this to be addressed.

The provider employed maintenance staff to ensure the premises were well-maintained and safe. There were systems in place to ensure any maintenance needed was responded to promptly. We saw records of checks that had been carried out on equipment and the premises.

People's and relatives' comments relating to staffing levels were variable and implied there were on occasions insufficient staff available to meet people's needs. A person told us, “Things are improving now. There are a lot more staff now then there used to be. A relative told us, “Changes are being made. There were times when we could hardly see much staff around but there’s definitely more of them around to help now.”

Staff told us there had been a lot of management change but overall they felt supported working at the service and had a good team. A member of staff told us, “There has been so much change over the past few months, it makes me feel anxious. Every manager has their own approach and things are always changing. I hope things settle down amongst the management so we can work on improving things here.” The manager told us they were keeping staffing levels under constant review. The service had recently appointed a unit manager to support the units.

There were enough staff supporting people at the service during our site visit. People were observed to have their 1:1 staff as stated. People using the service received support as needed and required. The numbers and skills of staff matched the needs of people using the service.

Staff recruitment files reviewed for 5 members of staff found appropriate checks had been completed before a new member of staff commenced working at the service. This included an application form, exploration of employment history and gaps in employment, written references, proof of identification and Disclosure and Barring Service [DBS] checks. These checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff told us they were supported with an induction when they first started working. However, no information was available on staff files to demonstrate a robust induction had been completed to enable staff to carry out their role and responsibilities effectively. Staff did not receive regular support in the form of a supervision. Staff told us they do not have regular supervisions and this information concurred with the home's supervision matrix. This meant there were no effective arrangements in place to monitor staffs' practice, performance and professional practice. Although there was no impact for people using the service, staff training records showed not all staff employed at the service had received all mandatory or refresher training. A health professional told us, “It would be beneficial to have more training to new starters prior to starting their job and ongoing training for all staffs.” Suitable arrangements were not in place to ensure all staff employed received appropriate training, a robust induction or regular supervision. This was a breach of Regulation 18 [Staffing] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

Staff confirmed they received infection prevention and control (IPC) training and felt confident to support people with their personal care. However, not all staff had completed their training as per the services training matrix. We were informed by all staff we spoke with that there was sufficient personal protective equipment (PPE). The manager carried out regular audits to monitor the cleanliness of the service.

Staff had personal protection equipment situated throughout the service giving them easy access to wear when needed. The service was clean and tidy with no odours and people commented on how clean they found the service.

People usually received their medicines safely. However, staff were not always following prescribers’ instructions when managing people’s diabetes. This meant people could be at risk of experiencing negative effects related to their diabetes such as high blood glucose levels. People’s care plans were not always up to date or reflective of their care needs. Care plans for specific conditions did not contain person centred information. Where medicines were used to manage anxiety and/or agitation, there was no information to support staff with how or when to use these medicines. People were prescribed regular medicines to manage distress and anxiety. People were not supported by alternative techniques such as de-escalation and psychological interventions to help reduce the need for medicines to control behaviour

Staff told us they received regular training on medicines administration and management. This included a 4-day induction period followed by routine competency checks. Additional training was available on medicines use from various healthcare professionals such as nurses and pharmacists.

There were processes in place to support the safe and effective management of medicines at the service. Staff were not always following the process for recording the administration of when required medicines. Medicines were ordered and stored safely. Where medicines incidents and errors had occurred, these were investigated in line with the policy and learning was shared. The service was completing regular audits which were highlighting areas for improvement. However, the audit did not contain a sign off for when actions identified had been completed. We saw evidence of learning and improvements from audits being implemented.