Longley Hall Limited

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

Improvements were required about how the service monitored incidents of behavioural distress, we found no impact to people and where people had an increase in incidents this was appropriately actioned, and referrals made to external professionals. All other accidents and incidents were monitored, and lessons learned to ensure people were safe. Improvements were required in relation to records to ensure the service were following the principles of the Mental Capacity Act (MCA), this was commenced at the time of our inspection and required embedding into practice. Staff kept both digital and paper based records, which meant records could be shared between services as appropriate. People were protected from the risk of unsafe harm. Staff were trained and understood their responsibilities to safeguard people from the risk of abuse. Risks posed to people were effectively assessed and managed. Risk assessments were in place and regularly updated. Systems were in place to ensure the environment and equipment was safe for use. However we found some radiators uncovered, which could pose a risk of burns, action was taken to address this at the time of our inspection. IPC policies and procedures were in place to protect people from the risk of infections. Medicines were safely managed.

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.

Relatives told us staff were responsive to their loved ones needs. Incidents were monitored and we found where people had accidents or incidents, appropriate action was taken, such as referrals to external professionals where required. For example, staff had recently worked closely with external Positive Behavioural Support (PBS) teams, had explored themes and trends, and introduced different strategies for this person. This had resulted in a significant reduction in this person's incidents, meaning they had an improved quality of life and access to their community.

The registered manager told us they monitored and reviewed accidents and incidents, these were also recorded and discussed during weekly senior management risk meetings. Staff understood their roles and responsibilities to record and report accidents and incidents. One staff said, “I would inform team leader and complete an incident report, we then talk about how we might need to action or change things. We always talk about everything in staff meetings.”

We received positive feedback from partners and external professionals about the services learning culture. They told us the service was learning lessons and had improved since our last inspection. A professional said, “Lots of improvements have been made.”

Systems were in place to monitor most accidents and incidents and the registered manager reported notifiable incidents to the relevant agencies. However, some improvements were required about how incidents of behavioural distress were monitored, this was a recording concern, we found no impact to people as appropriate action was taken to address any concerns.

People and relatives told us they were happy with their support. People received support from external professionals and advocacy services were used to support people to make decisions about their placements. 1 person was being supported to move to another flat within the service. Their relative said, “They are planning to move [name] to her own flat on a 1:1 basis. I am happy that this and I have been included in the discussions. People benefited from several visits to the service prior to living there, to ensure they were happy with the placement and were suited to the environment.

Staff were aware of the importance of sharing information between services and supporting people to transition between service. One staff said, “Before [name] came to us, we had lots of information, we had visits and we discussed likes and dislikes, [name] got to know staff before they moved in.”

We received positive feedback from partners who worked with the service and both digital and paper-based care records were utilised, to ensure the service could easily share information where appropriate.

The provider had processes in place to ensure safe systems, pathways and transitions were effective. Pre admission assessments were in place and detailed people’s needs, prior to them living at the service. The registered manager explored people’s suitability to live with their peers and suitability of the environment.

People were protected from the risk of unsafe harm. People and relatives told us they were safe living at Longley Hall. A relative said, “Yes, [name] is safe, they are happy.”

Staff were trained and understood their responsibilities to safeguard people from the risk of abuse. Staff told us people were safe, and they felt comfortable to report concerns if required. One staff said, “I have had safeguarding training, people here are safe. I have never had to report any concerns, but I would report to the manager if needed and would feel comfortable to do so.”

We observed staff treating people with kindness, dignity and respect. Staff were seen offering choices to people and seeking their consent before giving support.

Policies and procedures supported safe practice and staff were made aware of how to spot signs of abuse and how to report incidents. Systems were in place to monitor safeguarding concerns and notifiable incidents were reported externally as required. The provider did not have appropriate systems in place to ensure staff worked in line with the principles of the MCA. Whilst consent was sought from people on a day to day basis, appropriate records were not in place to ensure peoples capacity to consent had been appropriately assessed. This is covered in the effective section of this report.

People were supported to take positive risks, to enable them to live more independently. For example, the service had supported 1 person to enable them to use public transport independently and another person was working towards administering their own insulin. Relatives told us staff understood and managed people’s risks. One relative said, “[Name] has seizures, there is a care plan in place to make sure that everyone knows what to do. I am confident that things are in place. They make sure that new staff know and understand what to do and what to watch out for.”

Staff had recently received PBS training, which provided them with knowledge and skills to manage behavioural incidents and reduce distress for people. PBS risk assessments and care plans detailed how staff manage incidents and staff told us of positive strategies used to appropriately support people during times of distress, such as providing people with activities they liked.

Care records evidenced people were supported safely. For example, where people required specialised diets due to being at risk of choking, guidance was in place for staff, and we observed people receiving food and fluids in line with their needs.

Risks posed to people were effectively assessed and managed. Risk assessments were in place and regularly updated. Where people had nutritional or mobility needs, referrals were made to external professionals, such as speech and language therapists (SALT) and occupational therapists.

Relatives told us the environment had improved. Where people used equipment, such as wheelchairs, regular servicing and checks were in place to ensure they were safe for use. Fire safety precautions were in place and people had personal evacuation plans in place, which provided guidance to staff and emergency services.

Staff told us the environment and equipment was safe for use. Staff told us the environment had improved. The registered manager was aware of her roles and responsibilities to ensure equipment checks were up to date and told us how they report and monitor environmental concerns.

We saw people being supported safely to do the things they wanted around the service, including assisting people to mobilise. Staff had undertaken appropriate checks to enable them to support people into the community in people’s cars. Medicines were safely stored in peoples flats and we saw food stored appropriately.

Longley Hall Ltd is a supported living service, CQC do not regulate the premises. Premises are the responsibility of the landlord. Systems were in place to ensure the premises were safe. However, we found radiators which were uncovered, which could place people at risk of burns. This was requested to be completed by the landlord of the premises on the day of our inspection. Business continuity plans detailed how the service responds to untoward events, such as a loss of electricity.

People were supported by enough staff. Where people received 1:1 support, this was provided and people, relatives and staff told us there were enough staff to safely support people. One relative told us, “There is a staff team leader for the day and the night, this has helped having one main contact person.” People were supported by a core staff team and the service did not use agency staff at the time of our inspection, which improved continuity of care for people. Relatives told us staffing had improved and their relatives received support from familiar staff who knew them well.

Staff felt supported in their roles and received regular supervisions and appraisals. The registered manager completed staffing observations which monitored staff's overall performance and interactions with people. One staff said, “There are enough staff, it is staffed well, and no agency is used, this helps. Staff are good to people have good relationships with people, everyone is so friendly. “Another staff said, “[Name] incidents have reduced because of a stable staff team, we have a good team, and the managers are great.” The registered manager told us having a core team of staff had helped the service improve and provided a better quality of life for people. Another staff said, “Now we have a consistent team, 1 person likes to have female staff, they can have this now and they are much happier and content.”

We saw people being provided with enough staff. People mostly received 1:1 support and we observed staff supporting people to attend activities and do things which were important to them. For example, we saw staff helping people to complete jigsaws, building blocks and taking people out in the car.

Whilst overall training provided had improved since our last inspection, some staff were overdue refresher training in several subjects, the provider had recently changed training providers which had caused some delay, and refresher training was booked for the upcoming weeks. Some specialist training had been implemented, including diabetes and epilepsy training and staff had received training in relation to caring for people with a learning disability and/or autism. Staff were recruited safely and appropriate pre-employment checks were in place.

People were supported by staff to clean their own flats. Relatives told us the service was clean. One relative said, “There is a good standard of hygiene and cleanliness.” And another relative said, “[Relative] gets help with preparing food, cleaning their room guidance around their day to day needs.”

Staff were trained and understood their responsibilities about how to keep people safe from the risk of infections. Staff told us they had access to personal protective equipment and had received training about to appropriately use and discard of this. One staff said, “We wear PPE, and we wash our hands regularly.”

Staff were observed to be wearing PPE and we saw staff encouraging and supporting people to clean their own spaces. 1 person proudly told us how they had cleaned their room.

Policies and procedures were in place and systems were in place to monitor staff practices. IPC audits were undertaken, and people had cleaning schedules, to encourage people to be involved in their own cleaning.

The GP practice nurse said the current manager had made a lot of improvements over the past year and they were now “a lot more confident” about the care people received. People had protocols containing guidance for staff on the right use of their ‘when required’ medicines, including preparations applied to the skin. Protocols were signed by the manager and the GP practice nurse, who is a prescriber.

Staff told us that the GP practice nurse visited the service several times a week and supported them to provide good care. Staff understood people’s medicine support needs and preferences. Managers understood the principles of STOMP.

Medicines were stored safely in the three people’s rooms we visited and in the central storerooms. Non-medicated creams were managed well.

With one exception, accurate records of the administration of medicines were kept. Weekly medicine audits ensured that medicines were managed safely. People all received an annual health check. However, a process was not in place for ensuring that NHS patient safety alerts were received and communicated to staff. Staff we met were unaware of alerts about sodium valproate, which can affect fertility and should not be taken by women of child bearing age unless effective contraception has been prescribed due to the serious side affects this can have on an unborn child.