Background to this inspection
Updated
7 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
This was a focused inspection due to concerns raised by the local authority safeguarding team and to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 10 (Dignity and Respect), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
As part of this inspection we also looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by two inspectors on each day.
Service and service type
Longfield Residential Home - MD is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three relatives about their experience of the care provided. We spoke with nine members of staff including the manager, senior care workers, care workers, a chef, a housekeeper and an activities co-ordinator.
We reviewed a range of records. This included five people’s care records and multiple medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. However, we did not receive all the evidence requested on a number of occasions. We continued to liaise with the local safeguarding team and local authority to ensure people using the service were safe.
Updated
7 January 2022
About the service
Longfield Residential Home – MD is a residential care home providing personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 24 people. The service specialises in caring for people living with dementia. The service is in a residential area close to Blackburn town centre and local amenities.
People’s experience of using this service and what we found
We found significant safeguarding concerns and avoidable harm had occurred within the home. Risks to people’s health and safety were not always assessed and managed and accident and incident records were not always completed or completed in full.
Infection control systems and processes were not always safe. Staff were seen on several occasions not wearing masks correctly and correct personal protective equipment (PPE) was not always available in PPE stations. The manager had not ensured Government guidance was being followed regarding temperature checks and vaccination status of agency staff. There was continued risk of head lice transmission within the home. Clean towels were being stored in a toilet area and a communal bathroom was being used as a sluice area for commodes.
Systems and processes in place did not protect people from the risk of abuse. Monitoring systems put in place by the manager were not being followed by staff; the manager was unaware of this. 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. For example, the manager had segregated two people in a separate area of the home until advised not to do this by the local safeguarding team.
The service was not caring, and people were not treated with dignity and respect. People using the service had clothing not belonging to them, clothing was not neatly folded in drawers, some people had no underwear and some underwear was in a poor state. People appeared as though their hair had not been brushed. One relative spoke of being ‘shocked’ at their family member’s presentation and another relative told us “Mum’s hygiene is shocking.”
The provider’s systems to assess, monitor and improve the quality of the service had not identified the concerns and shortfalls highlighted in this report. There was a lack of oversight by the manager who was unaware of several of the issues we found on inspection. The service did not promote a positive culture and people did not achieve good outcomes, which is evidenced throughout this report. When one staff was asked if they would be happy for their family member to live in the service, they told us, “Not a chance.”
For more details, please see 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 inadequate (published 6 November 2021) and there were multiple breaches of regulation. At this inspection we found insufficient improvements had been made and the provider remained in breach of the regulations.
Why we inspected
The inspection was prompted in part due to concerns received about the safeguarding of vulnerable people and continued concerns about a lack of improvement in the care and treatment of people using the service. A decision was made for us to inspect and examine those risks.
We also undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 10, Regulation 12, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this focused inspection and remains inadequate.
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.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
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
The overall rating for this service is ‘Inadequate’ and the service remains 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.