Long Meadow

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

People were supported to keep safe because staff and leaders understood their responsibilities to report, record and review incidents and accidents. People and relatives felt able to raise any concerns about safety and were informed of actions taken to keep people safe. People were protected from the risk of abuse. Risks to people were identified and assessed. People were cared for in a safe environment, free from hazards and with access to equipment they needed to keep safe. The home was clean, and staff followed best infection prevention and control (IPC) practice. Medicines were managed safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with relatives about their experience when a loved one was involved in accidents or incidents. Overall relatives were satisfied by how these were managed by the service and felt assured action was taken to keep people safe. One relative said, “I am satisfied that [staff] certainly keep [person] safe and sometimes they are super cautious that I know everything, but that’s a good thing that they act on the side of caution.” Another said, “They have contacted me if [person] had a fall or involved in an altercation – I have been satisfied that they have put residents’ photos on their doors because it prevents confusion about rooms, as that’s what caused the altercation.”

Staff were aware of their responsibilities to report and record incidents and accidents. They confirmed these were discussed at team meetings and learning was shared to improve safety. Leaders understood the importance of promoting a positive culture around safety. The manager explained they had implemented daily huddles with staff so that any concerns or incidents were raised and discussed promptly. This also helped to demonstrate to staff that as a manager they were visible and proactive in response to any concerns. They explained work had been completed in relation to documentation and completing incident records, and the standard of reporting had improved. One example shared was in relation to identified weight loss, and changes to the kitchen and menu off the back of this.

Systems were in place to report, review and analyse accidents and incidents. This meant themes and trends could be identified and action taken to mitigate risks to people. For example, falls were reviewed monthly and information such as times, locations and action taken were analysed to ensure all appropriate action was taken to keep people safe.

We received feedback that historically the transition into the service had not always been well managed, however relatives felt assured that for future admissions this would be a smoother process due to confidence in the leadership of the service.

Leaders demonstrated a commitment to ensuring safe transitions into the service. For example, referrals were only accepted once a robust assessment had been completed with people and their families. Staff felt the information gathered from people and their families which informed care and support plans was sufficient to help them support people safely.

Professionals fed back to us that improvements had been made and staff understood the importance of knowing what was important to people and their families in order to provide good person-centred care. They confirmed that appropriate referrals were made, and staff were receptive to advice and recommendations. They felt positive changes had been driven by the new manager and staff were prepared to try different approaches to support people.

A checklist was completed when assessing new referrals, this was completed with the person and their family to ensure a robust assessment was carried out and the service could be assured they were able to meet the person’s needs. A resident of the day initiative was implemented, this meant one day per month each person’s care and support was reviewed.

All people and relatives we spoke with felt people were protected from the risk of abuse. One relative said, “Oh yes, [person] doesn’t have any injuries, they seem fully content, they are well looked after and the staff on the ground are kind and take care of [person].” And “[Person] is so settled there – I have never seen any signs of physical abuse and [person] tells us how lucky they are to be there – no signs of anxiety and we have seen a change in them since being there”. All people and relatives knew how to raise concerns should they have any and confident these would be listened to by management.

Staff understood their responsibilities to report abuse and confirmed they had received safeguarding training. Staff were able to tell us the types of abuse, how they monitor and how they would report any concerns. Leaders worked alongside the local authority in relation to safeguarding referrals. This led to improved reporting and understanding of safeguarding at the service. Action was taken to improve safety, such as additional training and competencies.

Staff were responsive to people’s needs and any requests for support were seen to in a prompt and dignified way. We saw staff routinely checked in on individual’s well-being, including those who were not able to verbally communicate. This showed staff were vigilant to changes in people’s needs.

Records showed safeguarding referrals were made appropriately and the manager completed reviews and investigations where required. Staff had received safeguarding training. The service made appropriate applications for deprivation of liberty safeguards (DoLS), and a tracker was in place to monitor the progress of DoLS applications.

Relatives felt risks were well managed and staff knew people well. One relative told us, “Yes there are risks; [person’s] deterioration's, [falls] managed with fall pads.. They got a nutritionist to come and see [person] and was assessed for high protein drinks, which they were cautious about giving without assessment.” Another said, “[Staff] seem much more switched on about [person’s] moods and needs.” And, “They know [person] well, they will tell me about their day when I go in to visit; all the staff”.

The manager had a good oversight of people's risks and their planned support. Leaders spoke positively about the stable staff team who knew people well. Staff we spoke with were able to tell us about individual's risks and how they support people to keep safe.

Staff supported people safely and in line with their risk assessments. For example, we observed safe moving and handling practice by staff.

Risks to people were now robustly assessed and regularly reviewed. For example, some people using the service communicated signs of distress. There were care plans in place which provided clear guidance on how to support them safely and different techniques to use. Furthermore, where people had been identified as at risk of leaving the premises and being unsafe without staff support there was an appropriate risk assessment in place.

Relatives had noticed improvements in the security, cleanliness and overall maintenance of the building. One said, "Yes its always clean and there are no objects obstructing the way – It’s definitely safe and secure”. People and relatives confirmed people had access to their specialist equipment.

Staff told us they had enough equipment to support people safely. We discussed the reporting procedure for maintenance issues which all staff were aware of and felt worked well, explaining that issues were addressed quickly, especially if they had an impact on people’s safety. Leaders explained they were in the process of recruiting a full-time maintenance staff member but had support from other services’ maintenance team as required. Leaders told us work had been completed following our last assessment to improve the safety of the environment, including the security of the outdoor area.

Overall, people were cared for in a safe environment free from hazards. There was some signage around the service to help people navigate. People had access to their specialist equipment, such as walking aids, slide sheets or pressure relieving mattresses. We observed these to be in good condition. During our assessment work was underway to address improvements identified through a recent fire safety inspection.

Some improvements were required in relation to the documentation of environmental checks as these had not always been completed. For example, gaps in water temperature checks. We discussed this with the manager who was aware and informed us that they are using support from another service as an interim measure whilst in the process of recruiting a new full time maintenance staff member. Action plans were in place to address environmental improvements required, such as fire safety and the kitchen.

People told us staff were responsive to their needs. Some had noted that communal areas were sometimes unsupervised. We received feedback such as “I don’t see many staff there [communal areas] as they must be busy looking after people in their rooms.” And “They are usually in the next room, next door to the TV room with the door open so they can hear what’s going on – sometimes they sit with the residents.” One relative raised concern they felt their loved one was at risk of isolation due to minimal interaction with people and staff. We fed this back to the manager who confirmed they will review this with the family. Overall relatives felt there were enough staff to keep people safe. One said, “Previously I would have said no, whereas now there are always enough staff; I don’t know the ratio per head, but staff are much more visible now.” Relatives felt staff were suitably trained. "Yes, they are caring and attentive and kind and they have training to be calm." And “Staff are always welcoming and seem to know what they are doing – That makes me feel confident [person] is being taken care of.” A new call bell system had been introduced, where people wore individual wristbands which they could use to alert staff they needed support. We were able to see the system used which would inform staff where the person was when they pressed the alarm. However, many people at the service were not able to use the system due to cognitive impairments.

Staff felt there were enough staff for the number of people using the service at the time of our assessment. Staff fed back they worked well as a team and provided support where required. Leaders used an external resource to plan staffing levels. This was based on people’s dependency needs and was reviewed regularly. Agency staff were no longer used, and leaders spoke of a consistent and stable team who worked well together.

We carried out a short observational framework for inspections (SOFI) during our assessment. Whilst everyone did get some form of interaction with staff, staff interactions with people were primarily functional, for example if they wanted a drink. Staff did not always have time to sit and spend time with people. The SOFI showed us that staff were responsive to people's needs and requests for support. Mealtimes were fully supported by sufficient staff. Communal areas were not always supervised, but staff were observed to frequently walk through these areas.

Training records showed some gaps in training. We discussed this with the manager who was able to demonstrate that training compliance was closely monitored, and staff had been given deadlines for training completion. Systems were in place to effectively calculate safe staffing levels. Rota’s showed staffing levels were in line with these calculations. Call bell audits were completed which allowed leaders to oversea the timeliness of staff’s responses to people’s requests for support. These audits showed staff were quick to respond to people’s needs.

People told us their bedrooms were regularly cleaned. All relatives explained they had noticed improvements in the cleanliness of the service. One relative told us, “Yes, it is, very [clean]! Recently they have been more thorough – I have noticed a difference.”

Staff felt improvements had been made in relation to infection prevention and control (IPC) practice. For example, now changing into uniform whilst at work, and having adequate stock of cleaning supplies. Staff told us they had good clear instructions for using cleaning products as appropriate guidance and risk assessments were now in place. Staff understood that regular audits were completed in relation to IPC and hand washing, and why these were important. Staff were able to talk us through daily, weekly and monthly cleaning tasks. A resident of the day initiative was now in place, which meant one day a month a person’s bedroom would undergo a deep clean. Staff confirmed there were now enough cleaning staff, and they were not required to undertake care tasks.

The service was clean and tidy. Staff were observed to follow best practice guidance in relation to IPC practice. This included the use of personal protective equipment (PPE). We observed domestic staff present around the service, carrying out cleaning tasks throughout the day.

Regular IPC audits were carried out which generated clear action plans where areas for improvement were identified. Actions were reviewed and signed off. This also checked on staff competency in relation to reporting infections, correct use of PPE and hand hygiene. Staff had completed IPC training.

Relatives were satisfied with how medicines were managed at the service. "[Person] has medication, and I believe they get it correctly”. People were supported to receive pain relief if needed. "I have no reason to believe it wouldn’t be given – They have definitely sought medical attention when [person] reported pain”. Relatives confirmed reviews of medicines were held with the GP and they were involved, "Yes it’s been reviewed regularly, and they discuss it with me, so I am involved”.

Leaders explained there were robust systems in place to oversee medicines at the service. This included regular checks and audits both internally and externally. Leaders were assured their senior staff team were competent in medicines management. Staff managed medicines safely, and followed best practice relating to storing, administering and recording medicines. Staff were able to explain what they would do in the event of a medicines error, or if they had concerns with the medicines people were taking. Staff worked in partnership with the local pharmacy and GP.

Medicines were managed safely. Records showed people received their medicines as prescribed. Medicine stock was correct and best practice was followed in relation to storage of medicines. Staff were trained and competent in administering medicines. Where people were prescribed medicines to manage behaviour on an as required basis, records showed this was not used regularly and staff used other techniques prior to medication to manage signs of distress. Where people were prescribed medicine to be administered covertly, appropriate assessments were in place and consultations were had with pharmacy and GP.