The inspection site visit took place on 12 and 13 November 2018 and was unannounced. Long Lea Residential Home 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 care home is a two-storey building and is registered to provide care for up to 35 people who do not require nursing care. At the time of our inspection visit there were 33 people living at the home.

There was a registered manager in post. 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 management structure of the service changed in July 2017. A new nominated individual acquired the service and employed a new registered manager in November 2017, however the service maintained its original provider registration with the CQC.

We last inspected this service in November 2017, when we rated the service as ‘Requires Improvement’ overall. Following the last inspection, we asked the provider to complete an action plan to show how they would improve the rating of all the key questions to at least good and how they would address the breach of regulations 12 HSCA 2008 (Regulated Activities) Regulations 2014. At our last inspection we found people's medicines were not always administered as prescribed, and medicines records did not always demonstrate that medicines were administered consistently. Some prescribed creams were being administered by care staff, but were not recorded, and stock checks of medicines were not accurate. The provider’s medicine audits were not always effective.

At this inspection, we found some improvements had been made, however the changes did not reach the required standards and further improvements were still needed to assure us care was delivered effectively to meet people’s needs. We have rated the service as ‘Requires Improvement’ in the key questions of safe, effective, responsive and well-led and ‘Good’ in all other key questions. Therefore, the overall rating remains ‘Requires Improvement.’ This is the second consecutive time the service has been rated ‘Requires Improvement’ since their management restructure in July 2017.

Staff were very busy and sometimes struggled to meet people’s individual needs. Improvements were required to ensure people’s capacity was assessed in accordance with the Mental Capacity Act 2005 [MCA]. The provider’s quality monitoring system was not always effective. It was not clear if some people had received their creams as prescribed.

Staff felt supported and were trained to meet people’s needs. The registered manager checked staff’s suitability to deliver care and support during the recruitment process. Staff understood their responsibilities to protect people from the risk of abuse.

People told us staff were caring and they were encouraged to maintain important relationships. People were supported to maintain their health and to eat and drink enough to maintain a balanced diet. Staff knew people and understood their likes, dislikes and preferences for how they wanted to be cared for and supported. Staff respected people’s right to privacy and supported people to maintain their independence.

People were satisfied with the service and were positive about the leadership of the service. People decided how they were cared for and supported and staff respected their decisions. People knew how to complain and could share their views and opinions about the service they received.

We found a breach 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 ba

This inspection took place on 23 November 2017 and was unannounced.

Long Lea 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. Long Lea Residential Home provides personal care and accommodation for up to 35 older people.

The home 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.

From July 2017, the home was under new ownership, and a new management team was appointed. The new manager became ‘registered’ with us in November 2017.

People’s medicines were not always administered as prescribed, and medicines records did not always demonstrate that medicines were administered consistently. Some prescribed creams were being administered by care staff and were not recorded, and stock checks of medicines were not accurate. Audits designed to check medicines practice was safe and in line with best practice had not identified some of the issues we found.

Risk assessments were in place where risk had been identified, but had not always been reviewed in line with the provider’s policy and procedure. However, staff knew about people’s risks and managed them effectively.

People told us they felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people and understood what action they should take in order to protect people from abuse. The provider ensured staff followed safeguarding policies and procedures.

There were enough staff to meet people’s needs effectively, and staffing levels had recently been increased following feedback from staff. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

People were asked for their consent before staff supported them. Where people lacked capacity to make particular decisions, this had been assessed to ensure people were protected. Where people lacked capacity and had been deprived of their liberty to keep them safe, the provider ensured they applied to the relevant authority to ensure this was done lawfully.

Effective induction of new staff was not yet in place, and staff were not always supervised according to the provider’s policy and procedure. The provider had a plan in place to ensure this happened by the end of December 2017. The provider was moving towards a new training system, and plans were in place to ensure staff received the training they required to update their knowledge and skills.

People and relatives told us staff were respectful and treated people with dignity. We saw this in interactions between people, and records confirmed how people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals when needed and care records showed support provided was in line with what had been recommended. People’s care records required updating to support staff to deliver personalised care and give staff information about people’s communication needs, their likes, dislikes and preferences. People were not always involved in how their care and support was delivered, but the provider had plans in place to ensure this process was completed by the end of December 2017.

Systems to ensure the service was effective and continued to improve were not yet working

We carried out an unannounced comprehensive inspection of this service in September 2016. At that inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and issued a 'warning notice' to the provider, requiring them to make improvements in how they checked the quality of the service provided and made improvements as a result. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the regulations.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Long Lea Residential Home on our website at www.cqc.org.uk.

At our previous inspection in September 2016, we gave the home a rating of 'requires improvement.' We found the provider was in breach of Regulation 12(2) (g) the proper and safe management of medicines; of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not always receive their medicines as prescribed and guidance was not always available for staff to ensure people received their medicines in a safe way. At this inspection, we found improvements had been made to ensure there was a safer, and more consistent system in place to ensure people were administered their medicines safely and as prescribed. This meant the provider was no longer in breach of the regulation.

At our previous inspection, we found the provider had not always assessed the risks to the health and safety of service users and had not done all that is reasonably practicable to mitigate any such risks. This was a breach of Regulation 12 (1) (2) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found improvements had been made to ensure risks to people were identified, assessed and managed effectively to keep people safe. This meant the provider was no longer in breach of the regulation.

At our previous inspection, we found the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had some systems in place to monitor the quality of the service provided but had not ensured these were effective.

This meant opportunities to identify where action was required to implement improvement were missed. We also issued the provider with a Warning Notice in relation to governance, requiring them to take action to improve this. At this inspection, we found improvements had been made to ensure a range of audits were in place so the provider could identify areas for improvement and take action as a result. This meant the provider was no longer in breach of the regulation, and the warning notice had been met. However, some improvements were still required.

The provider sent us an action plan as required, telling us how they planned to ensure they met the legal requirements. We found these actions had been carried out by the provider.

Long Lea residential home is one of two services provided by Dwell Limited and provides accommodation and personal care for up to 35 older people; over two floors. At the time of the inspection 35 people lived at the home.

The home is required to have a registered manager in post. 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post, who is the owner / provider of this service. The registered manager splits

The inspection took place on 20 September 2016 and it was unannounced.

Long Lea residential home is one of two services provided by Dwell Limited and provides accommodation and personal care for up to 35 older people; over two floors. At the time of the inspection 35 people lived at the home. Long Lea was last inspected by us in October 2015 and we found a breach in the regulation relating to the safe management of medicines. We gave the home an overall rating of ‘requires improvement.’

The home is required to have a registered manager in post. 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post, who is the owner / provider of this service. The registered manager splits their time between this home and their domiciliary care service.

People had not always received their medicines as prescribed because staff could either not find them or stock had run out because staff had not ensured there was enough. Guidance was not available for staff to refer to in order to ensure people received ‘when required’ medicines or prescribed creams in a safe way.

People felt safe living at the home because staff were there to support them when needed. Staff were trained to know what abuse was and how to report any concerns to the registered manager.

Some risks to people’s health and welfare were assessed but actions were not always put into place to reduce the risk of harm or injury to people. Some risks were not assessed and staff did not have the information available to refer to, if needed, to know how to keep people safe.

Staff worked within the principles of the Mental Capacity Act 2005 when supporting people with personal care. People had choices offered to them about what they wanted to eat and drink and were supported to maintain their health and see a GP, for example, if they felt unwell.

Staff had received training and felt this gave them the skills and knowledge they needed to meet people’s needs effectively. Staff promoted people’s privacy when they were supported with personal care.

People said staff were, overall, kind to them and involved them in making decisions about their day to day care and how they spent their time. There were planned group activities for people to take part in if they wished to do so and people told us they enjoyed the activities.

Systems were in place to assess the quality of the service provided but audits were not always effective and improvement was not implemented when needed. Risks associated with the management of medicines and risk of cross infection had not been identified by checks undertaken. Care plan reviews had not identified where improvement was needed.

We found breaches of the regulations relating to the safe management of medicines, the safe care and treatment of people and the governance of the home. You can see what action we told the provider to take at the back of the full version of the report.

When we visited Long Lea we met with most of the people using the service and spoke to two people in more detail about their care. We met and spoke with two visiting relatives, four members of staff, the care manager and the registered provider.

People using the service told us staff were kind and they felt well cared for. One person said, “You couldn’t wish for a better home. Everyone is so kind.”

We found that people’s needs were assessed and care and treatment was planned and delivered in line with individual care plans. People looked contented and relaxed.

We watched how the staff supported the people in their care. We saw people were treated with dignity and respect. We observed that staff understood and attended patiently to their needs.

Staff told us they had regular training, which meant they could support the specific needs of people who used the service. One staff member told us, “I enjoy working here, we have a great team and the management listen to what staff say.”

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would speak to the manager I wasn’t happy about something." Another person told us, “If we have any concerns at all we can tell them (the staff).”

We visited Long Lea on 17 May 2012 where we met most people using the service and spoke with nine people individually. We also spoke with a visiting family member, the registered manager, matron and care staff.

We asked people about the care and support provided to them. People spoken with told us that the care provided was good and they had no complaints about the home. One person told us, “I can’t say a bad word about this home, the staff are second to none.”

We also observed the care that people received. We found that staff treated people with kindness. They knew people as individuals and understood their personal needs and ways of communicating those needs.

A visiting family member told us that the staff always make them welcome. They told us their relative's needs were fully met and that they always looked well cared for. They said they had no concerns about the home and commented, “I can truthfully say my relative has never been looked after so well. They are very happy here, as am I.”

We spoke with people about social activities and we were told there was “plenty to do” at the home and they are “never bored.” A number of people told us about the arrangements for the forthcoming Queen’s Diamond Jubilee celebrations. They told us they had been very much involved in the planning of the event at the home.

People told us they felt safe and able to report any concerns they may have. One person told us, “There’s nothing to grumble about here, everything runs like clockwork.”

People confirmed that they were very happy with the service. They felt listened to and had a say in how the home is run. We saw that regular residents and relatives meetings are held and one person commented, “Not a day goes by without a chat with the manager and matron.”

When we looked around the home we saw people's rooms were clean and suitably furnished. People had been able to personalise their rooms and bring in small items of their own furniture if they wished. One person told us, “I have a very comfortable room. I’m on the ground floor and my friends are just along the corridor.”

Staff spoken with told us that they were happy working at Long Lea. They said that they received regular supervision to monitor their care practices and had access to training to keep their skills up to date.

We found that all the people we spoke with were happy with the care and support they receive at Long Lea.

We observed good interaction between staff and the people who live at the home. People told us staff were kind and attentive to their needs and treated them with respect and listened to them. People said, “the staff always speak nicely to me and are very polite”, and “All the staff are kind and willing to help.”

A person who had been living in the home for a number of years told us, “I can’t fault anything, I would recommend this home to anyone.”

Other comments from people included,

“The staff always speak nicely to me and are very polite”,

“I get up when I want to and usually go to bed at 8pm”,

“I spend a lot of my time in bed, but that’s my choice, I’m very comfortable in my room.”

People knew how to make a complaint and people told us they did not have any concerns about the home, but would talk to staff if they did. People were asked for their views on the quality of care in the home through annual surveys. Regular residents meetings are also held. We were told by a person, "I would speak up if necessary, but everything is perfect here."

The inspection took place on 5 and 7 October 2015. The visit was unannounced on 5 October 2015 and we informed the provider we would return on 7 October 2015.

Long Lea Residential Home provides accommodation, personal care and support for up to 35 older people, living with physical frailty due to older age or health conditions. At the time of the inspection 35 people lived at the home.

The home is required to have a registered manager in post. 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post.

Most people told us they received their medicines when required. Although staff were trained to administer medicines we observed that safe administration practices were not followed which presented a risk to people. We found that people’s medicine records were not completed as required and were unclear. This meant that staff did not have the information they needed about the dosages of medicines administered to people.

People told us that they felt safe living at the home and with the staff working there. Staff told us they knew how to keep people safe from the risk of harm or abuse. Risks to people were assessed and care plans were in place. However, we found that care plans were not always up to date with the current information about people’s needs. Staff told us they felt they had the training and skills needed to meet people’s needs. We found that staff did not always have a clear understanding of the Mental Capacity Act 2005. There were sufficient staff on shift to meet people’s needs. People and relatives said they felt staff were kind and caring toward them. We observed this during our visit and saw staff treated people with respect and maintained their dignity.

Staff were supported in their roles and said they felt confident to raise concerns with the registered manager and that they would be listened to. Staff attended regular meetings and felt informed of changes in people’s needs. Systems were in place to monitor the quality of service provided but we found that audits did not always identify where actions were needed to make improvement. People’s personal information was not kept securely.

We found a breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2010.

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