Longmead Court Nursing Home

Longmead Court Nursing Home is a residential service and provides personal and nursing care to older people in Black Notley near to the town of Braintree in Essex. The service can support up to 54 people and there were 31 people in residence when we inspected.

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

There were systems in place to manage infection control. The service was clean and comfortable and there were no unpleasant odours. All staff undertook COVID-19 tests in line with the government guidance in order to protect the people they cared for. Visits by relatives had been facilitated to the service which was welcomed by staff and people using the service.

The registered manager had ensured that all staff and people living in the service had the information they needed about vaccines to ensure that they could make informed decisions and there was a high take up of the vaccine.

There were enough staff available to meet the needs of the people living in the service. The process to recruit staff was thorough and new staff were provided with training to ensure that they had the skills they needed to provide effective care.

Risks were assessed and people had been provided with the equipment they needed to mitigate risks. Equipment was regularly checked to make sure it was safe. People had good access to healthcare and regular surgeries were held at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by a kind and friendly staff team who cared for them with respect. People had access to a range of activities to promote their wellbeing.

Care plans were detailed and informative and underpinned the delivery of personalised care. Systems were in place to escalate and hand over information about peoples changing needs.

The registered manager was visible within the service and knew each person well. They had a good level of oversight of the care provided. Staff morale had improved, and staff told us that that they received the support they needed.

The provider had a range of systems in place to monitor the quality of care provided.

For more details, please find the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 8 November 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Longmead Court Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Care was not consistently good, or person centred. Most staff were kind, but delivery largely focused around the competition of a task.

There was not always enough staff to meet people’s needs. There was a reliance on agency staff which impacted on the support and care provided. Staff received training, but it was not always in depth.

Mealtimes were poorly organised, and people did not receive the support they needed.

The environment was generally clean but there was a lack of dementia friendly signage which meant that it was difficult for people to orientate themselves around the building.

People had care plans in place to guide staff on people’s preferences and how to support people. However, information was not always up to date or sufficiently detailed which meant that people were at risk of not having their needs met in a safe and effective way.

There were some daily activities, but they were limited, and people were at risk of isolation.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests.

Information about how care was delivered was not always documented. Oversight systems were not effective as they were not identifying shortfalls.

Complaints were investigated and responded to in a timely manner.

Incidents had been notified to the CQC in line with the legal requirements however notifications had not been undertaken for people who had been deprived of their liberty. This had been identified and was underway at the time of the inspection.

The provider had systems in place to audit the care provided but there were gaps in audits and they had not prevented some of the shortfalls in the quality of service provision.

A new manager was in post and recruitment was underway for a new deputy manager and clinical lead. The manager had identified some of the shortfalls and had a plan with timescales for addressing the issues.

Rating at last inspection

Longmead Court Nursing Home was rated good at the last inspection which was published on 01 April 2017. This was a planned inspection based on the rating at the last inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 to (MCA) and (DoLS).

Deprivation of Liberty and best interest assessments were in place to provide staff with guidance to protect people where they do did not have capacity to make decisions and where there freedom had been restricted for their own safety.

People had their nutrition and hydration needs met through effective planning and development of nutritious menus. Menus were varied and took into account people’s dietary preferences.

The service had built up an effective and supportive relationship with the general practitioner service

Prior to coming to the service people and their families were given information to assist them to decide if Longmead Court was an appropriate place for them while an individual needs led assessment was carried out. This was to determine if the service could meet the person’s needs.

Each person had a care plan which was regularly reviewed to help staff provide care around their assessed needs. Other professionals involved with peoples care and families informed us the service staff worked with them and kept them informed appropriately

People’s privacy and dignity were respected by staff who were familiar with their needs and took into account how people wanted to be cared for. .

The service had a complaints procedure which was available for people to use if so required. People did tell us that they liked the activities but would have liked more.

Surveys were carried out by the service to identify how the service could continue to be improved. The senior staff also arranged staff meetings to inform and listen to the views of the service staff. People using the service relatives and staff told us that the management staff were approachable and supportive.

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.

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.