Archived: Longview Care Home Limited

Longview is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Longview accommodates 28 people.

The service had a registered manager. 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.

The service was viewed by people we spoke with as very caring. We received many positive comments about the attitudes of staff aand the owners. For example, “Longview is an exceptionally well run home, the staff and owners are approachable, considerate and professional. I have seen other homes and Longview is head and shoulders above all of them,” “Care is excellent,” “Longview has always appeared to us excellent in every way. It is secure, more than adequately catered for by staff who appear both well trained and caring,” “I could not be happier with the care received from the excellent staff,” “I hold up the up most respect for Mr Patel and his care team. I find his approach to care very impressive and indeed just what is needed for local folks in dire need of good quality care,” “Immaculately clean and extremely well appointed…Very homely and comfortable.” “Happy and contented,” and “Staff at the home are very supportive and helpful.”

People told us they felt safe, and we also received positive comments from relatives that the service was “Safe and secure,” and staff were “watchful and very quick to respond,” if there were any problems. The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were enough staff on duty to meet people’s needs. The service had a suitable recruitment procedure, and appropriate checks were carried out on new staff to ensure they were suitable to work with vulnerable people. Staff were suitably trained. Staff received a comprehensive induction when they started to work at the service, and they received regular supervision to provide them with feedback and guidance about their work.

The medicines’ system was well managed, medicines were stored securely, and comprehensive records were kept regarding receipt, administration,and disposal of medicines. Staff who administered medicines received suitable training.

The service was exceptionally clean and hygenic. A relative told us, “I have always found Longview clean, fresh and well maintained. Unlike (my relative’s) previous home there is no smeall of urine.”The building was well decorated, well maintained and well furnished.

Assessment processes, before someone moves into the service are comprehensive. These assisted in helping staff to develop detailed care plans. The registered manager and staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.

People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a high standard. Meal times were very well organised, and were a sociable occasion. Comments about food included, “The food has been to a good standard and my relative is eating very well.”

The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers. External professionals were very positive about the standards at Longview. For example we were told, “It is a really caring home,” “ In my view, and the view of the team Longview is one of the best residential homes in the county.”

The majority of people lacked capacity due to their dementia. Where necessary suitable measures had been taken to minimise restrictions. Where people needed to be restricted, to protect themselves, and/or others, suitable legal measures had been taken. No physical restraint techniques were used at the service. Staff had received suitable training about mental capacity.

Everyone we saw looked well cared for. People were clean, well dressed, their hair combed nicely and fingernails clean and nicely manicured. People told us, “They look after me well. I find it easy to talk to the staff,” and “(The staff) respect you and are kind.” We observed staff working in a caring and respectful manner, respecting people’s privacy and dignity.

The service had a comprehensive activities programme. There was at least one, if not two, organised activities a day such as external entertainers, exercise sessions, art sessions and a drumming group. Outside the activities sessions we saw staff sitting with people, chatting with them and carrying out one to one activities such as completing jigsaws or looking at the newspaper with a person.

The registered manager, and the management team were well respected by people, relatives, staff and external professionals. They were described as “Dedicated,” “Caring,” and “Extremely helpful.” Staff also said team working at the service was good, and team members were supportive and communicated well with each other.

There was a suitable quality assurance system in place. An annual survey was completed, and the results of this were positive. The registered manager had a hands on approach, wanted to get things right, learned from mistakes and had a comprehensive system of checks and audits in place.

Relatives said communications were good between the service and them. They said they were always informed and consulted about their relative’s care. A relative said, “I am included in everything. There is good communication.”

There was a registered manager at the service. The owner of the service is also the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We inspected Longview on 6 and 7 June 2017. The inspection was unannounced. The service was last inspected in October 2015 when it was rated as ‘Good’, and was found to be meeting the requirements of the regulations.

People and their relatives told us the service was safe and staff were supportive.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately. However we were concerned there should have been more proactive contact with the safeguarding authority about two matters, and these should also have been reported to the Care Quality Commission through our notification procedure. There was no system in place to enable the registered manager to have an overview of any incidents that occurred in the service. We have made a recommendation about the monitoring of incidents in the report.

People received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff training was delivered to a good standard. Staff received updates, at regular intervals, about important skills such as moving and handling. Staff also received training about the needs of people with dementia, but we have made a recommendation about staff training on the subject of dementia.

We were concerned about some moving and handling procedures for example, how some people were assisted in and out of their chairs. We saw some cases where people who used wheel chairs did not have foot plates which put people at risk of injury.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals.

There were enough staff on duty and people received timely support from staff when it was needed. Call bells were answered promptly and we observed staff being attentive to people’s needs.

We had mixed views of the care we saw. Although there were examples were care practice was good, we did see some instances where people were ignored or their privacy was not respected. Views of people we contacted were all positive. For example people told us, “It is lovely here,” “Staff do their best for everyone,” and “They are ever so kind to me.” Relatives told us: “Longview is excellent in every respect,” and “The care has been outstanding.” A professional told us, “Staff are friendly and courteous.”

The service had activities organised. A structured activity took place at least once a day These activities included musical entertainers, African drumming, fitness and art sessions.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were happy with their meals. Everyone said they always had enough to eat and drink. People were provided with some choice of meals (for example if they did not like, or eat, what was on the menu, they were provided with an alternative). However, support people received at meal times was not always appropriate. For example staff did not always sit with people, or talk with them, when they were assisting them.

People, their relatives and external professionals we contacted said if they had any concerns or complaints they would feel confident discussing these with staff members or management. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed and had generally suitable quality assurance systems in place to ensure the service received feedback from people involved with the service. Relatives told us “(The owners) are very professional, very caring people.” A staff member said,” “(The owners are) Very fair…very much involved.” Professionals told us: “The owner is a man of the utmost integrity and is absolutely passionate about providing a first class service.” We have however stated that management approaches do need improvement, particularly in relation to the monitoring and improvement of some staff practices, concerns which we have highlighted elsewhere in the report.

We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe? Yes, at the time of this inspection we judged the service was safe.

People we spoke with were positive about the staff who worked at The Longview Care Home. People told us, 'We've never had any reason to worry about things here. My (relative) is clean, well looked after and happy at Longview'. People told us staff were ' professional and supportive'.

We spoke with two professionals who visited the home on the day of inspection. People told us, 'This is an excellent home, one of the better services of this type that I visit. It always seems friendly and happy place'.

The service had a well organised medication system. The system was well managed and regularly audited. Records were accurate and up to date.

Is the service effective? At the time of this inspection we judged the service was not fully effective.

People all had individual care planning records, which set out their care and support needs. Care plans contained satisfactory information and were accessible to staff. People said staff met their relatives' needs and responded promptly when they needed assistance. People told us and we saw in people's' records, that they had access to doctors, community psychiatric nurses, psychiatrists, chiropodists and opticians.

However, we found the issue of ensuring appropriate consent was not following the home's own policy guidance concerning the Mental Capacity Act (2005) or local guidance.

Is the service caring? Yes, at the time of this inspection, we judged the service was caring.

Relatives of people who used the service, and external professionals such as GPs and district nurses said they were happy with how the service supported people and found the staff to be professional and helpful. A relative told us 'it is very good. I have no concerns at all with the care.'

From our observations of the level of care carried out, conversations with people who had experience of the service and a review of the records we assessed, we judged that individual wishes and needs were taken into account and respected.

Is the service responsive? Yes, at the time of this inspection, we judged the service was responsive.

We observed first-hand how responsive the providers of Longview were when issues concerning people were brought to their attention. In one instance immediate contact with Social Services was made to ensure the welfare of one person who had raised an issue with being geographically distanced from a close relative.

Everyone we spoke with said the staff treated people with respect and dignity. We observed and saw from records that people were able to be involved in a wide range of activities including exercise classes, visits from a hairdressing service and sessions at the home with a number of local musicians. One person told us how much they had enjoyed a flamenco dancer coming into the home. A relative of a person who lived at Longview told us, 'I feel there is a good level of activities and entertainment to keep people stimulated. We are made to feel welcome at all times'. From our conversations with relatives, and management, staff and other professionals we formed the view that the service was diligent about ensuring they could meet the changing social and support needs of each person supported.

Is the service well-led? Yes, at the time of this inspection, we judged the service was well led.

Staff, relatives and external professionals were all positive about the management of the service. People told us management would listen to staff and also to any concerns raised by people who lived at Longview and/or their relatives and were supportive. One external professional who visited Longview on the day of inspection told us, 'I see strong leadership in the provider. They set high standards'.

Longview had a system to check people were happy with the service. This included systems of survey and audit. There was also a system to monitor accidents and incidents. People's personal care records, and other records kept in the home, were accurate and complete.

We observed the providers took a personal and hands-on approach to the management of the home. They were interacting with staff and people who lived in the home often and had a personal investment in the care and welfare of everyone who lived or worked at Longview as summed up by a senior member of care staff, 'It is a great place to work. There is good morale amongst the staff here. (The providers) care very much about the welfare of the residents and also staff. We can discuss anything with them'.

At the inspection we used our 'Short Observational tool For Inspection' (SOFI) tool to observe care. During the period of observation we recorded every five minutes the interactions between staff and people who used the service, the activities people were engaged in, and noted people's moods. From the exercise we judged the care given during the observation period was to to a good standard.

Everyone we spoke with was happy with the home's standards. Comments we received included 'It is very good, the food is ok and the staff are very nice, 'It is brilliant'nothing is too much trouble'mum is very happy,' 'my mother seems very happy, she is always smiling' and 'I cannot find anything to fault it'everyone has been very kind.'

We judged people were treated with respect and dignity, and there were satisfactory levels of activities available. People received appropriate support with their personal care and health needs. Accommodation was well furnished, decorated and maintained to a good standard. The home was very clean and there were no offensive odours. There was a satisfactory system of staff recruitment. There were satisfactory numbers of staff on duty. The service had a suitable quality assurance system to ascertain the views of people, and to ensure standards were maintained and improve where necessary.

People who lived at Longview were complementary about the staff who supported them. Relatives told us 'to me, they provide excellent care', 'very good and staff are 'happy and helpful'.

Both visiting professionals were complementary about the standards of care from a physical and mental health perspective.

We found, people were protected from the risks of inadequate nutrition and dehydration.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

There was an effective complaints system available.

However, we found people were not always supported in promoting their independence and people's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

People's needs were assessed, however, care and treatment was not always planned and delivered in line with their individual care plan.

People were not always protected from the risks of unsafe or inappropriate care and treatment, because accurate and appropriate records were not maintained.

One person who lived at Longview told us they liked living at the home and said 'the staff are kind and helpful to me and make me feel safe and looked after'. Another person told us 'the staff are smashing people, very kind and helpful'. People confirmed the staff were always polite.

A visitor we spoke with was positive about their experience of visiting the home and said staff communicated with the family about their relatives care, they felt listened to by the staff and were welcomed to the home at any time or day.

People told us, and we saw, that the home was clean and hygienic throughout with no odours detected anywhere.

We observed the mealtime and saw people did not consistently receive assistance with their meal in a discreet way that showed respect for people's dignity.

We were not able to review all of the documentation we requested, for example policies and procedures and staff records. This was because the registered manager was on holiday and had not left access to these documents for the staff.