Longmead Court Nursing Home

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

We identified 1 breach of the legal regulations. The provider had not managed risks to people’s safety effectively or acted promptly to learn from safety incidents. People's medicines were not always managed safely. The provider's safeguarding processes were not always effective. Staff were not always available to provide people with personalised care. Environmental and infection prevention and control concerns were not always well managed.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Concerns about people's health and safety were not always promptly addressed to ensure lessons were learnt. We found examples of concerns raised by people’s relatives, where the provider had concluded improvements were needed. However, we found these improvements had not always been implemented effectively or monitored to minimise the risk of a reoccurrence.

Staff told us they knew how to record accidents and incidents. However, we found staff had not always documented accidents and incidents accurately. This meant there was a risk opportunities to learn may not be identified. The management team told us they discussed incidents with staff and shared learning. However, where repeated concerns were being documented there was a lack of robust discussion and analysis to demonstrate how lessons were being learnt.

The provider's processes for addressing and learning from safety concerns were not effective. Incident reports did not always reflect actions taken and the provider’s monthly review of incidents and accidents did not robustly identify concerns such as unidentified bruising and skin tears. This meant there was a lack of investigation into these concerns to understand the causes and ensure future risks were mitigated.

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 were not always protected from the risk of abuse. We found safeguarding concerns were not always managed appropriately and actions were not implemented promptly to ensure people were kept safe. The provider had ensured information about how to raise safeguarding concerns was available to people and relatives; however, there was a lack of easy read or large print versions available for people to access if required.

At the time of the assessment, not all staff had complete, up to date safeguarding training. However, staff we spoke with knew how to report safeguarding concerns appropriately. Staff lacked understanding about people’s capacity to consent to care and treatment and how to protect people’s rights under the Mental Capacity Act 2005. For example, in 1 person’s care plan staff had signed their consent documentation, with no explanation or evidence to explain why the person or their representatives had not signed themselves. Following our assessment, the management team confirmed safeguarding and MCA training and knowledge needs were being addressed with staff.

We observed people receiving safe care from staff during our assessment, with no safeguarding concerns identified.

The provider's safeguarding processes were not robust. We found some safeguarding concerns had been fully investigated with appropriate actions taken; However, other safeguarding concerns had not been identified or investigated. This placed people at potential risk of harm or abuse.

Risks to people's safety were not well managed. People did not have up to date and accurate risk assessments in place for all risks to their health and safety. For example, we found a lack of detailed guidance about how to manage 1 person’s epilepsy safely and no information about the risks and impact of people’s long term health conditions on their safety. Where people required textured diets due to the risk of choking, we found significant concerns with the accuracy of the information in people’s care documentation. We found information was contradictory, unclear and out of date. This placed people at risk of serious harm. Staff were not able to demonstrate people were being provided with adequate fluids due to poor recording and this meant we could not be assured people were drinking enough to stay hydrated.

Staff did not always demonstrate they knew how to manage risks to people safely. For example, staff responsible for preparing people’s meals did not demonstrate a good understanding of texture modified foods terminology and guidelines. They were not able to tell us who specifically needed specialised diets, only the number of modified diets which were needed. This meant there was risk staff may not have the appropriate knowledge or information to support people safely. The management team told us they were aware of the inconsistencies and lack of detail in people’s risk management documentation and were in the process of making improvements to the risk assessment and review process to ensure staff had clear, up to date guidance to follow.

During the first morning of the on-site assessment, we observed concerns with 1 person’s pressure relieving mattress which was displaying a fault. We raised this concern with the management team. However, the fault was not corrected until lunchtime. On day 1 of the on-site assessment, we found people had not always been supported to reposition in line with their assessed needs. This increased the potential risk of people developing pressure areas. We also observed concerns with the temperature of the building and the frequency and amount of fluid offered to people throughout the day. The provider responded promptly to our feedback about people’s hydration, amending their monitoring processes to better reflect how much people were drinking.

The provider's processes for reviewing and managing risks were not robust. We identified concerns with the management of people’s choking risks and dietary needs and with the completion of people’s daily records and monitoring charts. We also found concerns with the provider’s management of people’s individual fire safety risks. People’s personal emergency evacuation plans (PEEPs) were poorly completed and lacked relevant details relating to their health needs and the impact these had on their safe evacuation. Following our assessment, we sought immediate assurances from the provider about the management of risk. The provider evidenced they had reviewed people’s eating and drinking assessments and made referrals where needed. They also confirmed they had reviewed people’s PEEPs and relevant risk assessment documentation.

The environment people lived in was not well maintained. We found communal spaces and facilities were very worn and in need of redecoration. People’s mobility aids and equipment were not always stored appropriately and safely. This meant the environment and equipment did not always meet people’s needs.

The management team told us they were in the process of implementing a redecoration and refurbishment plan for the service and showed us the improvements already made to the decoration of the communal hallway. However, these refurbishment plans were not yet completed at the time of the assessment. Staff were provided with training in the use of people’s equipment and checks had been completed to ensure equipment was safe to use.

We observed a number of concerns with the condition and standard of decoration in the service. We shared these concerns with the provider, who confirmed they were aware and were starting to address the issues.

The provider’s processes for managing the safety of the environment were not robust. Actions identified by the provider’s fire risk assessment, fire officer’s visit and through their own routine fire equipment checks had not been addressed promptly. Some fire safety checks were overdue. This had been identified by the provider prior to the assessment but actions were still ongoing. Following the assessment, the provider sent an updated fire safety action plan to address the concerns identified.

Staff were not always visible and available to provide people with personalised care which met their needs and preferences. During the assessment, we noted a number of people were cared for in bed and we found they spent a considerable amount of their time alone. Whilst staff were carrying out regular safety checks and were available to provide task-based care; there was a lack of meaningful engagement and interaction. We also found people who wished to walk around were repeatedly encouraged to stay seated as staff were busy providing support to other people.

The management team told us people’s individual dependency levels were recorded. However, no dependency tool was used to calculate the overall staffing levels required throughout the service. They also confirmed they were currently employing only 1 member of activities staff. This meant there was only 1 member of staff responsible for organising and coordinating social activities throughout the service. The management team told us they used their own judgement and experience to assess the staffing levels required. We received mixed feedback from staff about how well staffed the service was. Comments included, “I think we need one more member of staff during the day and at night and we need to make sure we are providing people’s 1:1 care without the 1:1 staff getting pulled away” and “Generally the staffing levels work ok when everyone is here and nobody is off sick but it would be nice if there was an extra member of staff to provide more interaction for people.”

During the assessment we observed there were not always enough staff deployed, particularly where people required nursing care and support. We observed staff rushing. For example, where they were supporting people to eat and drink this was completed quickly and there was a lack of interaction and engagement to make sure the person was happy with the pace of the support.

The provider did not have a system in place to calculate what staffing levels were required to meet people’s needs. Following the assessment, the operations director confirmed they had now implemented a dependency monitoring tool to ensure accurate staffing levels were maintained. Staff had not always completed all relevant training to support them in their roles. Prior to the assessment, the provider had organised a number of face to face training courses for staff covering a wide range of health care needs. However, at the time of the assessment, the provider’s training matrix evidenced a significant number of staff did not have up to date mandatory eLearning in subjects such as safeguarding, basic life support and fire safety awareness. The management team were aware of this and were speaking to the relevant staff to ensure this was addressed promptly. The provider had completed relevant recruitment checks prior to staff starting work. However, we found staff did not always have a full employment history recorded. Following the assessment, the provider confirmed they would review the relevant recruitment files to ensure all information was documented correctly.

People were not always protected from the risk of infection. Communal toilets, shower rooms and bathrooms were not cleaned to a high standard and mould, flaking paint and limescale were visible on bathroom fittings. This presented an infection control risk.

Staff we spoke with were able to tell us about good infection prevention and how to report any concerns. However, we found not all staff had up to date infection prevention and control training. The management team told us they were aware of the concerns with communal bathrooms and toilets and the impact of the poor condition of these areas on effective infection prevention and control. A refurbishment plan was in place at the time of the assessment.

We found a number of communal areas which appeared unclean and in poor condition. We found slings used to aid people’s transfers from bed were not always kept in a clean area. Slings were being kept in storerooms, on top of wheelchairs or hung on top of each other. This is not recommended best practice in controlling the risk of infections. Personal protective equipment (PPE) stations throughout the home were not in line with good infection control guidelines with opened glove boxes and apron rolls left on top of waste bins and handrails. This meant there was a risk the clean PPE may become contaminated before being used by staff. We found some bins in the toilets and bathrooms were overflowing.

The provider completed regular infection prevention and control audits. However, we identified a number of infection control risks which had not been addressed at the time of the assessment.

People’s medicines records were not always accurate or up to date. This meant there was a risk people may not receive their medicines as prescribed. People’s medicines care plans had not been updated to reflect changes on their medicines administration records (MARs). For example, 1 person had a detailed care plan about when to administer medicines to support them during periods of distress. However, we found this medicine had been discontinued by the GP and they were now receiving a different medicine. Protocols were not always in place for people’s ‘as and when required’ (PRN) medicines. This meant staff did not have clear guidelines on when these medicines should be offered to people. People’s application charts for creams administered by care staff during personal care did not provide any direction for where or how to apply the cream. This meant there was a risk people may be supported to apply cream incorrectly. On day 1 of the on-site assessment, we observed the administration of people’s medicines. We found there was only 1 nurse providing medicines to 31 people who required nursing support. This meant the administration round lasted until 12pm and people did not receive their medicines in a timely manner.

Staff and managers told us medicines were usually administered more promptly than we observed on day 1 of the assessment. The management team said the concerns we found with the timeliness of medicines administration related to staff sickness. However, we were not assured robust protocols were in place to ensure managers were made aware of concerns with the administration of medicines as the management team were not aware of the delay until we raised it with them during the assessment. Following our assessment, the management team confirmed they had met with staff to discuss protocols to minimise the risk of a reoccurrence.

The provider did not have robust processes in place for managing people’s medicines safely. People’s medicines records were not always accurate and contained misleading information which may pose a serious risk to the safe administration of medicines. Handwritten entries and amendments on people’s MAR charts were difficult to read and some were illegible. This meant staff may not know how to give medicines correctly.