Long Meadow Care Home

Long Meadow Care Home is a residential care home providing personal care to up to 35 people. The service provides support to adults under the age of 65, adults over the age of 65, adults living with dementia and adults who require support with their mental health. At the time of our inspection there were 32 people using the service.

People’s experience of using this service and what we found

Infection prevention and control practices were not always followed. We have made a recommendation around this. Governance oversight did not identify some of the issues found on inspection such as risk to people were not always assessed to minimise and manage the risk of harm and mandatory recruitment checks were not always completed.

People were protected from the risk of abuse or neglect; medication was managed safely and lessons were learnt when things went wrong.

Renovation works were being completed in the premises with a plan for further works to be completed. People had choice and control over their decisions and staff had the skills and training to provide safe care. People were supported to eat and drink to maintain a healthy lifestyle and staff worked with other agencies to ensure people had access to health and social care services.

Staff were caring and respected people’s privacy and promoted dignity and respect.

People received personalised support and there were a wide variety of activities offered. Complaints were responded to appropriately and staff had a good understand of how to provide good end of life care.

The registered manager promoted a culture of person-centred care and acted with a duty of candour. People were included in the development of the service and the manager promoted a culture of continuous learning and development.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 15 October 2020).

The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last seven consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to governance audits at this inspection.

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home had ample supplies of appropriate personal protective equipment (PPE). This was stored hygienically and kept safe. Staff were provided with appropriate areas to put on, take off and dispose of PPE safely. Staff completed online training, including putting on and taking off PPE safely, hand hygiene and other infection control and COVID-19 related training and updates.

The provider’s infection prevention and control policy was up to date and had been updated with COVID-19 government guidance. Risk assessments for staff and people were in place to minimise further risks.

Social distancing practices were followed for people and staff where appropriate. Any new admissions to the home were carried out safely and in according with government guidance.

People and staff were tested regularly which helped identify cases of COVID-19 in a timely manner.

Long Meadow Care Home accommodates up to 35 people over the age of 18, including people living with dementia in one adapted building. On this inspection we were informed that 27 people used the service.

People live in single rooms on two floors. The service is provided in an old building which has been adapted over the years to provide a care provision. There is a small new build wing on the right of the building.

People’s experience of using this service and what we found

People, relatives and staff felt there were positive changes taking place and the new registered manager was listening to their views and opinions. In the last three months since the registered manager’s appointment, there was evidence of improvement around leadership, oversight and management within the service.

The assessment, monitoring and mitigation of risk towards people who used the service had improved. This meant risks to people's health and safety were reduced, although additional work was needed to ensure the new practices were sustained.

People received their medicines on time and when they needed them. Improvements had been made to the recording of the application of topical medicines, such as external creams and ointments.

People felt safe and well looked after by the staff. All areas were clean, tidy and there was sufficient cleaning taking place to keep people safe from the risk of infection. Relatives said they were confident that staff provided good care in a safe way.

People, relatives and staff said that communication within the service had improved. Relatives were kept informed, of their family member’s health and welfare, throughout the last six months when they were unable to visit the service due to the Corona virus outbreak.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care plans and risk assessments had all been reviewed and updated, these covered specific medical conditions such as dementia and diabetes.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 15 May 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This is the seventh consecutive time the service has been rated requires improvement or inadequate.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 2 April 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Long Meadow Care Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Long Meadow Care Home accommodates up to 35 people over the age of 18, including people living with dementia. On the first day of inspection we were informed that 26 people used the service.

People’s experience of using this service

Improvements had been made to the standards of hygiene, staffing levels, medicine management, staff recruitment and the assessment and monitoring of risk to people. Further work was required to ensure the new processes were embedded in practice.

The recruitment of a new manager meant there had been some improvement around leadership, oversight and management within the service. The quality assurance and monitoring processes within the service were being completed and the service was moving forward. The assessment, monitoring and mitigation of risk towards people who used the service had improved. This meant risks to people's health and safety was reduced, although additional work was needed to ensure the new practices were sustained.

People said they felt safe in the service. All areas were clean, tidy and there was sufficient cleaning taking place to keep people safe from the risk of infection. There remained some minor issues around the frequency of bathing for some people.

The provider followed robust recruitment checks, and sufficient staff were employed to ensure people's needs were met. People's said they received their medicines on time and when needed. However, recording of the application of topical medicines such as creams and lotions was not consistent. We have made a recommendation about the management of some medicines.

The uptake and completion of staff training had improved, and staff had started to receive regular support and supervision.

Communication had improved but further work was needed to ensure this was consistent and effective. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People ate nutritious, well cooked food, but felt their options around choice of meals and variety within the menu was limited. The monitoring of people’s nutritional intake and weight loss had improved, and people were now being weighed on a regular basis. Their health needs were identified and staff worked with other professionals, to ensure these needs were met.

Care plans and risk assessments had all been reviewed and updated, but further development was needed to ensure these covered specific medical conditions such as dementia and diabetes. Short term care plans for issues such as antibiotic treatment had been introduced, but these were not consistently completed.

Staff knew about people’s individual care needs and people said they were happy with the support they received. Activities were taking place in the service, but these did not meet everyone’s needs. People who remained in their bedrooms received little or no social stimulation through one-to-one interventions. The provider had recognised that further work was needed to make activities more ‘dementia friendly’ and accessible.

People felt able to raise complaints with the service and the manager did look into these. However, there was no evidence that the provider had provided information for people, available in formats they could understand, in line with the Accessible Information Standard.

There was a continued breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

Exiting special measures – improvements

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated inadequate (published 27 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

At this inspection we found the three breaches of regulation were still not being complied with and a further six breaches of regulations were identified. These were Regulations 9, 10, 11, 13, 15 and 19 in relation to person-centred care, privacy and dignity, consent to care and treatment, safeguarding, environment and fit and proper persons employed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? to at least good. During this inspection we found the provider had made some improvements to the environment such as the purchase of new carpets and chairs, but there had been insufficient progress to improve the quality of care and risk management within the service. This left people at risk of harm.

Long Meadow Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 35 people over the age of 18, including people living with dementia, in one adapted building. On the first day of inspection we were informed that 33 people used the service. People live in single rooms on two floors. The service is provided in an old building which has been adapted over the years to provide a care provision. There is a small new build wing on the right of the building.

The provider is required to have a registered manager at the service, but at the time of our inspection the position had been vacant since August 2017. 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. There was an acting manager in place who assisted us during our inspection. We have referred to the acting manager as 'the manager' throughout this report.

The environment of the service was not clean and did not maintain standards of hygiene appropriate for the purpose for which they were being used. People were living in bedrooms that had unpleasant odours and dirty equipment such as overlay mattresses and commodes. People were not being supported to wash or bathe on a regular basis which meant their skin integrity was put at risk and they appeared unkempt.

Insufficient numbers of staff had impacted on all aspects of the service. The system used to determine the number of staff needed to meet people’s needs and deploy staff around the service was not effective. People were left isolated in their bedrooms and their calls for assistance went unanswered or there were delays in them receiving the support they needed.

The recording, administration and return of medicines was not managed appropriately in the service. People did not always receive their medicines as prescribed by their GP.

People were living in an environment that did not promote their wellbeing. There were some areas of the service that had unpleasant odours and the temperatures of bedrooms were extremely hot and people were visibly affected by this. There was no monitoring of the temperatures at the start of the inspection, but action was taken by the provider to put fans into bedrooms to reduce the heat.

The manager failed to notify CQC about safeguarding incidents and falls that resulted in people receiving injuries. Further action on this will be taken outside of this report.

We found that the recruitment process for staff was not consistently carried out in line with the provider’s policy and procedure. Documentation of employment checks and references was not carried out to a high standard so we could not be assured that people were protected from the risk of harm/unsuitable workers.

The induction, supervision and training programme for staff was not robust and did not adequately enable them to carry out the duties they were employed to perform. The provider and manager did not monitor this which meant people were at risk of being cared for by staff who lacked the knowledge, competency and skills to meet their needs.

People’s weight and nutritional needs were not being monitored by staff. Records of food and fluids were not consistently documented and people were not being weighed in accordance with their care plans. This put people at risk of weight loss and malnutrition.

The manager was unable to demonstrate they had a good understanding of the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). The legal requirements of the Mental Capacity Act (2005) had not been followed.

Care files were not completed in a consistent manner. Care plans were not up to date and documentation was not fully completed. This meant staff did not have appropriate records to show how they were meeting people's needs.

People’s privacy and dignity was not promoted through staff practice. The care and support delivered to people was insufficient to meet their needs. We found people were left without appropriate personal hygiene care, which resulted in them being dirty and unkempt. People felt able to raise complaints with the service and the manager did look into these. However, any action taken was not effective as there remained poor care practices within the service.

Activities were taking place in the service, but these did not meet everyone’s needs. People who remained in their bedrooms received little or no social stimulation through one-to-one interventions.

The lack of effective leadership, oversight and management within the service meant the quality assurance and monitoring processes were not used to drive improvement. The assessment, monitoring and mitigation of risk towards people who used the service was not carried out effectively. This included areas such as accidents/incidents, medicine management, hydration, bowel care, falls, pressure care and infection control practices. This meant people's health and safety was put at risk.

We found a breach of Regulations 9, 10, 11, 12, 13, 15, 17, 18 and 19 during this inspection in relation to person-centred care, privacy and dignity, consent to care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, staffing and fit and proper persons employed. You can see what action we told the provider to take at the back of this report. 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.

The overall rating for this service is Inadequate and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At the last inspection in October 2016 we rated the service as ‘Requires Improvement’ with no breaches of regulation.

Long Meadow Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 35 people over the age of 18, including people living with dementia in one adapted building. On the day of inspection we were informed that 27 people used the service. People live in single rooms on two floors. The service is provided in an old building which has been adapted over the years to provide a care provision. There is a small new build wing on the right of the building.

The provider is required to have a registered manager at the service, but at the time of our inspection the position had been vacant since August 2017. 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. There was an acting manager and a deputy manager in place who assisted us during our inspection. We have referred to the acting manager as ‘the manager’ throughout this report.

We found breaches of regulations 12, 17 and 18 during this inspection in relation to safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of this report.

The assessment, monitoring and mitigation of risk towards people who used the service with regard to fire safety, falls and infection prevention and control were not robust. This meant people were at risk of harm. Since our inspection the provider has received input from the North Yorkshire Fire Service to aid them in making improvements to fire safety. The infection prevention and control team in the community have also visited and produced a report for the provider to follow to improve practices within the service.

Recruitment of staff was carried out safely, but the levels of staff were insufficient to ensure people received timely care and support that met their needs. The manager took action on the second day of inspection to introduce a third member of staff onto night duty in response to our concerns.

Staff induction and training was not up to date and did not equip the staff with the skills and knowledge they needed to meet people's needs. Supervisions took place, but the lack of effective leadership and role models meant staff did not receive adequate support and guidance to promote best practice. Since our inspection the provider has sourced and implemented additional training for their staff.

The management team within the service did not effectively complete the quality assurance systems which were in place. Audits were completed but did not reflect the concerns raised by us with regard to fire safety, infection prevention and control, care documentation and people's health and well-being. There had been no action taken by the management team to address identified issues, which left people at risk of harm. Following the inspection the provider has given support and resources to the management team to make improvements within the service.

The recognition of safeguarding issues was not always robust.

Care files were not completed in a consistent manner. Care plans were not up to date and documentation was not fully completed. This meant staff did not have appropriate records to show how they were meeting people's needs.

The completion of food and fluid charts was inconsistent and the risks to people around hydration and nutrition were not always fully identified and reviewed by the care staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The majority of people felt their privacy and dignity was respected and maintained by the care staff and care practices within the service.

Long Meadow Care Home is a large property which consists of a Victorian main building with modern extensions. People have access to extensive gardens. The service has facilities to provide personal care for up to 47 older people, some of whom are living with dementia. The service is close to all local amenities.

At the last inspection on 8 April 2016 we found the provider had breached 10 regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person centred care, nutrition, dignity and respect, consent, safeguarding, staffing, recruitment, dealing with complaints and overall oversight of the home. There was also a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 Requirement to notify.

We issued a section 31 Notice of Decision to prevent nursing care being delivered at the home which came into force on 3 May 2016. All of the people who required nursing care were subsequently moved to alternative care homes.

We also imposed a condition on the registered provider’s registration to prevent people moving into the service. As a result 12 people were living in the service who required personal care only.

This service had been rated inadequate overall and had been placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

During this inspection the provider demonstrated to us that improvements had been made and the service is no longer rated inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The home did not have a registered manager in place. A new manager had been recently recruited and had commenced the process to register. 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.

We found that the systems in place to monitor and improve the quality of the service provided were still not robust enough to fully highlight safety and quality issues. We recommended that the registered provider develop systems to monitor quality and safety effectively. The registered provider and manager had already started to develop new checks and audits.

Hazards in the environment were not always acted upon by the manager and/or staff; for example we saw a hot food trolley stored in the main hallway which placed people at risk. The manager told us they would ensure staff were more aware of hazards. Appropriate checks of the building and maintenance systems were undertaken to ensure people’s health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. A new format was to be introduced to ensure all risk assessments clearly instructed staff on how to keep people safe.

We saw people’s care plans were person centred and written in a way that described their care, and support needs. These were regularly reviewed. They were not easy to navigate and changes were not always updated in all areas of the care plan. The manager told us of their plan to improve the system. We saw evidence to demonstrate people were involved in all aspects of their care plans.

We saw staff had started to receive supervision and appraisal to ensure they were supported. Staff had been trained and had the skills and knowledge to provide support to the people they cared for.

There were systems and processes in place to protect people from the risk of harm. Staff and the manager were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

People told us there were enough staff on duty to meet their needs and we observed this during our visit. We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before members of staff began work.

Care workers understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. Where people had capacity, records did not always fully reflect their choices, consents and decisions.

Appropriate systems were in place for the management of medicines and we saw people received their medicines safely.

There were positive interactions between people who used the service and members of staff. We saw all staff treated people with dignity and respect. Observation of staff showed they knew people very well and anticipated their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

People’s independence was encouraged. We saw there were a variety of activities available which people had chosen. People told us they enjoyed all activities on offer.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to raise concerns and the manager was aware of how to manage complaints appropriately.

We had carried out a comprehensive inspection of Long Meadow Care Home on 8 April 2015 where breaches in two of the legal requirements were found. The registered provider had failed to take proper steps to ensure care was planned and delivered in such a way that it ensured the health and safety of people. They had also failed to ensure there were sufficient, skilled and qualified staff employed at the home.

We asked the registered provider to send us an action plan outlining what steps they would take to ensure the home complied with the regulations. The registered provider failed to send this action plan. We are dealing with this matter outside of this inspection process.

Long Meadow Care Home is registered to provide residential and nursing care for up to 47 older people some of whom are living with a dementia. At the time of this inspection 29 people were living at the service and we were told that one of these individuals was in hospital.

The service does not have 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. A registered manager had been in post from 20 October 2015 until 9 February 2016.

The area manager who was also the nominated individual was working at the home and taking day to day charge.

At this inspection we found that there were breaches of 10 of the Fundamental Standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person-centred care, nutrition, dignity and respect, consent, safeguarding, staffing, recruitment, dealing with complaints and the overall oversight of the home. Also, there were failures to meet the requirements of regulation 18 of the Care Quality Commission (Registration) Regulation 2009 requirement to notify.

We had very serious concerns about the service provided at the home and found that staff had failed to meet the needs of the 29 people who used the service.

The registered provider had failed to ensure all of the people who used the service had received safe and effective care and treatment. We found they had not taken reasonable and practicable steps to mitigate the risks posed to people who used the service.

Care was delivered in ways that placed people who used the service at risk of exposure to significant risks to their health, safety and welfare. Some people had experienced acute illnesses which should have resulted in emergency services being called but the nurses on duty did not recognise these problems. In addition to this nurses were not meeting people’s needs. For example, people with unstable diabetes had not always received the appropriate treatment. Medication errors had led to people not receiving their required medication. We found that people had experienced avoidable harm such as dehydration, infections, missed percutaneous endoscopic gastrostomy (PEG) feeds, urinary catheter blockages where action was not being taken to mitigate risks.

The oversight and management of medication was inadequate and there were errors in the administration of medicines and the way these were recorded. Although the registered provider was aware of concerns relating to medicines they took no action such as daily checks, weekly audits to identify the source and eradicate the problem.

We found that GP and community nurse’s guidance was not adhered to, for example the GP requested that one person had blood taken for a test and over the course of the next six days this was not done. Emergency services, GPs and community nurses were not always accessed in a timely manner, which led to people not receiving the care they needed. For example one person sustained a head injury and the GP asked staff to completed half hourly observations. The records and discussions with staff showed that this had not happened. We found that the staff were not identifying and reporting safeguarding concerns.

The lack of registered manager, clinical oversight and leadership within the home had contributed to people who used the service being placed at risk of harm. This was because there was no continuity of care or effective sharing of essential information about changes to individual’s needs. Nurses, who had been identified as not fit to practice continued to be deployed at the home.

There was a lack of suitably skilled and experienced nursing staff employed and the provider relied on agency nurses to provide nursing care and support to people on a day to day basis. They had failed to check that agency staff had the skills and competencies needed to deliver the care and treatment that people needed such PEG feeds, and stoma care. Insufficient numbers of staff had received training in first aid.

There was a lack of information and guidance to ensure the care needs of people were met. In four of the 14 care records we reviewed we found that people had not been assessed and care plans were not in place. Other people’s care plans and assessments were inaccurate or out of date.

We found that the windows needed restrictors in place that could not be detached.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate enforcement action, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We re-visited the service to check that improvements had been made and that the home was now clean. We did not speak with people about cleanliness on this occasion as they had not raised any concerns in this area at our previous visit. We did however receive positive comments from a visitor about the standards of cleanliness in the home.

At the end of this inspection we were satisfied that significant improvements had been made and people were cared for in an environment that was clean and hygienic.

People's care plans contained a level of information that ensured their needs were being met. Information was being followed up in relation to people who had lost weight and care plans had been reviewed in a timely way. This meant that records about people's care needs were accurate and up to date and staff knew what was expected of them. People told us they were extremely happy with the care provided at Long Meadow. One person told us, 'The care is really good here, the staff are brilliant.'

We looked at how clean the home was. Although we noted the house was fresh-smelling and clean at first glance, when we looked further some deep cleaning was required and some infection control procedures were not being followed. This was in some toilet and bathroom areas and the main dining room. We also found that the records for cleaning schedules and audits were not accurate or up to date.

There were enough staff on duty to meet people's needs. Staff were receiving training on a regular basis and this was monitored by the manager.

There were quality monitoring programmes in place, which included people giving feedback about their care and treatment. This provided a good overview of the quality of the service provided and meant the quality of the service was being kept under review.