About the service

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 impro

This inspection took place on 25 July and 7 and 20 August 2018 and was unannounced. At the last inspection in October 2017 we rated the service as requires improvement with breaches of regulations 12, 17 and 18 in relation to safe care and treatment, good governance and staffing.

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 tha

This inspection took place on 31 October and 13 November 2017. It was unannounced on day one and announced on day two.

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 ar

We inspected Long Meadow Care Home on 11 and 19 October 2016. The inspection was unannounced on the first day and we told the registered provider we would be visiting on the second day.

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

Following receipt of serious concerns from external health and social care professionals we inspected Long Meadow Care Home on 8 and 13 April 2016. This was an unannounced inspection which meant that staff and the registered provider did not know that we would be visiting. We visited to check the actions the registered provider had taken to safeguard people who lived at the home.

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 co

This inspection took place on 8 April 2015 and was unannounced. We last carried out an inspection on 17 December 2013 where we found the home was meeting all the regulations we inspected.

Long Meadow is registered to provide residential and nursing care for up to 46 people. The home is in Ripon and is managed and owned by Long Meadows (Ripon) Limited. The building has been adapted and converted for its current purpose, providing modern facilities in a traditional, homely setting.

There was a manager in charge of the home who had only recently commenced in post but they had submitted their application to be registered to the Care Quality Commission. Since the inspection they have become registered. 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 new care planning process was being implemented which had resulted in a lack of, or inconsistent information recorded about how people’s needs were to be met. Specific areas of risk had not been assessed and addressed appropriately and this placed people at risk of harm.

There were sufficient staff available. However, there was an increased risk to the quality and continuity of care people received because of the lack of permanently employed qualified nurses and reliance on agency nurses to provide nursing care. .

Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to minimise the risk of staff being unsafe to work with vulnerable people.

Staff had received training with regard to safeguarding adults and they were able to tell us what they would do if they suspected abuse had taken place. Appropriate referrals to the local authority safeguarding teams had been made by the manager and we found evidence that they worked collaboratively with them.

The home had safe systems in place to ensure people received their medication as prescribed; this included regular auditing by the home and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was reassessed regularly.

Staff had received relevant training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

People had good access to health care services and the service was committed to working in partnership with healthcare professionals.

Staff were kind and caring and they respected people’s privacy and dignity and we observed this throughout our visit. Staff we spoke with knew people they were caring for well.

A lack of robust care planning impacted on people’s health and wellbeing. Care plans lacked information or contained contradictory information for staff. This meant there was a risk people would not have their care needs consistently met.

People knew how to make a complaint if they were unhappy and all the people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

People and their relatives completed an annual survey. This enabled the provider to address any shortfalls identified through feedback to improve the service.

Changes to management arrangements had impacted on the service provided. There were good auditing and monitoring systems in place to identify where improvements were required and the service had an action plan to address these.

When we carried out our inspection in October 2013 we looked at how clean the home was. At this visit we noted that improvements were needed and that the home was not clean.

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.

We spoke with six visitors, twelve people who used the service and some of the staff on duty. Before people received any care or treatment they were routinely asked for their consent. People told us they were involved in decisions about their daily lives and specific care needs.

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.

A number of the people we met during our inspection were able to tell us what they thought about the service. We engaged in conversation with 10 people, four visitors and four health care professionals, including a doctor. Everyone said they were satisfied and happy at Long Meadow Care Home. One person said; "We get excellent care here, we are very well looked after.” Other comments included; “I am not embarrassed when I am helped to take a bath, staff do it in a way to minimise that." One person summed up how they felt when the told us: "It's home from home here, it's lovely."

People who were able to comment told us that they were happy with the care and treatment they received. One person said; "I use my buzzer if I need the staff for anything, they come more or less straight away. ”Another person said; “I am quite happy here. The care is of a good standard.” One person said; “I want for nothing.” One visitor told us; “They are absolutely brilliant with my mum. We, the family, feel lucky to have found this place for her.” One visitor said; "The decor is looking worn, but the care is very good and that is more important." Health care professionals made positive comments about the way the home was managed and the staff.

One of the people using the service told us; "The nurses give me my tablets and I get them when I need them." Another person said; "I get my painkillers when I need them, the staff ask me throughout the day and night."

People told us that they found staff to be 'kind, appropriately trained and competent.' One health care professional said; "Staff are helpful and professional."

People told us that they were well looked after and that they were happy with the care they received. People made comments such as "It's very good here" and "I feel safe and comfortable here, knowing that I am looked after"

People were also positive about the staff who looked after them. People made comments such as "The staff are very pleasant and helpful" and "The staff are pretty good and they do respect my wishes"

Most people we spoke with also made positive comments about the quality of the food at the home and the choices available. For example, one person told us "The food is quite good you get plenty of it" People said they would either speak to a member of staff or the manager if they did have a concern or a complaint.

We also talked with several relatives who were visiting the home. They all spoke highly about Long Meadows. Some relatives told us that they visit the home on a daily basis. One relative said "It is exceptional care here. I wished that my relative had moved here sooner. There is always plenty of staff who give individual care. I do think they choose the right staff" Other relatives made comments such as "Everyone is so sociable. The staff here are tactful with people who have dementia. I know where I will be coming when I need care" and another relative told us "Long Meadows is absolutely fantastic. The staff are nursing my relative that well, which gives me confidence that the care is as it should be"

We also spoke with two health care professionals who both spoke highly about the home. One health care professional said "Brilliant home very friendly and helpful staff. They make you feel part of the team" another said "The care here is good. Nursing staff are helpful and considerate of patients and relatives needs"

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.