About the service:

• Longfield Manor is a care home that provides nursing and residential care. Longfield Manor is registered to provide nursing and accommodation for up to 60 people. People cared for were older people who needed nursing care, some people had complex health needs, and/or some people were living with dementia. At the time of our inspection there were 48 people living at the service.

• Accommodation is provided across the main building which is split into three areas and Rosewood unit. Rosewood is a unit for people living with dementia. All bedrooms were of single occupancy. People shared communal areas such as lounges and a large dining room.

• Longfield Manor is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is ongoing, and no conclusions have yet been reached.

• At the previous inspection in July 2018 we found four breaches of regulation in relation to safe care and treatment, staffing, person-centred care and governance. At this inspection we found that the provider continued to be in breach of these four regulations and was in breach of one new regulation in relation to dignity and respect.

People’s experience of using this service:

¿ The service met the characteristics of ‘requires improvement’ in each domain inspected. This meant that the provider needed to make some improvements to people’s support. These are detailed below.

¿ Some aspects of the service did not ensure that people remained safe from harm. There were elements of moving and handling practices that did not always ensure the safety of people at the service. The provider had not always fully assessed, and mitigated the risks, associated with repositioning people and the periods that people spent in their wheelchairs.

¿ The provider did not always ensure that staff had the training and skills to meet some of the needs of people who lived at the service.

¿ People’s dignity was not always promoted by staff.

¿ People did not always receive personalised support because peoples likes, dislikes and preferences had not always been identified and used in the care planning process. However, the provider had made improvements in the provision of activities and social engagement for people.

¿ Systems of governance and quality assurance were not always effective in highlighting shortfalls in the service.

¿ People’s health needs were met with the support of staff. Staff worked in partnership with other organisations to ensure people's needs were met.

¿ People medicines were administered and managed safely and effectively.

¿ People were supported to eat enough food and drink. People who required additional help to safely manage their nutritional needs were supported effectively by staff.

¿ Staff had made appropriate checks and carried out maintenance to ensure the service and equipment was safe for the people living at Longfield Manor.

¿ People received compassionate and caring end of life support. People’s complaints were addressed and dealt with appropriately.

¿ Recruitment processes were robust and ensured staff were safe to work with people before they started working at the service.

¿ People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

¿ People, their family members and staff told us that the management were responsive and had taken steps towards implementing improvements at the service.

More information is in the detailed findings below.

Rating at last inspection:

• At our last inspection in July 2018, the service was rated "requires improvement". Our last report was published in February 2019. This is the third time the service has been rated as requires improvement overal

The inspection took place on 23, 24 and 29 July 2018. This was a comprehensive inspection and it was unannounced.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have been made. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and July 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Longfield Manor is a care home that provides nursing and residential care. 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.

Longfield Manor is registered to provide nursing and accommodation for up to 60 people. People cared for were older people who needed nursing care, some people had complex health needs and/or some people were living with dementia. At the time of our inspection there were 44 people living at the home. Accommodation is provided across the main building which is split into three areas and Rosewood unit. Rosewood is a unit for people living with dementia. All bedrooms were of single occupancy. People shared communal areas such as lounge’s and a large dining room.

A manager was in post who had applied to become the 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.

At the last inspection in July 2017 we found the provider was in breach of Regulations associated with safe care and treatment, staffing and governance. The provider told us the action they were taking to meet the legal requirements. At this inspection we identified further improvements were required and the provider remained in breach of Regulations. We found risks were not always managed safely on behalf of people. We also found agency registered nurses were not always adequately trained to assist them in carrying out their role and responsibilities effectively.

Some group activities were offered to people. However, personalised activities and occupation were not consistently provided and information was not always in an accessible format. We observed caring approaches were not consistently applied and we made a recommendation to the provider about this. Systems were not always effective in measuring and monitoring the quality of the service provided. There were ineffective systems in place to drive continuous improvement.

People's consent to care and treatment was gained in line with the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and for staff to support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received supervisions and appraisals and they found the manager’s approach supportive.

People were provided choices daily regarding what food they ate and clothes they wore. Complaints were managed effectively. The provider sought feedback from people and their relatives regarding the care received and they spoke positively about the care provided.

The manager had sought information about the new Key Lines of Enquiry (KLOE) which the Commission introduced from 1 November 2017. They were keen to improve the quality and safety of care provided

This was an unannounced inspection which took place on 19 July 2017. We returned on 26 July 2017 to complete our inspection. The registered manager was given notice of this date as we needed to spend specific time with her to discuss aspects of the inspection and to gather further information.

The inspection was bought forward as we had been made aware that following the identification of risks relating to people's care, the service had been subject to a period of increased monitoring and support by commissioners. The service has been the subject of 16 safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. However, we used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May and August 2017, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Longfield Manor provides nursing care and is registered to accommodate up to 60 older people with a variety of physical and mental health needs. In the main building 14 beds are within a unit called Rosewood, which cares for people living with dementia. At the time of the inspection there were 39 people living in the main building and 11 people living in Rosewood. Bedrooms all have an en-suite toilet and sink. There are four lounges, a quiet room and a spacious dining room that overlooks well- tended gardens. Rosewood has its own lounge/dining room and access to a secure garden area.

We carried out an unannounced comprehensive inspection of this service on 11 October 2016 where it was awarded a rating of ‘Good’ in all domains apart from the ‘Safe’ domain which was rated ‘Requires Improvement’. No breaches of regulations were identified but recommendations to improve aspects of medicines management were made. An overall rating of ‘Good’ was awarded.

During our inspection the registered manager was present. 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.

Whilst systems were in place to assess, monitor and improve the quality of the service, these were not always effective, as they had not identified the breaches of regulation we found at the time of our inspection. The deployment and routine of staff in the morning meant that some people’s preferences, for example when they were assisted to get up, were not met. This issue had not been identified in any of the audits and checks completed by the provider or registered manager. Aspects of medicines management were not robust and these had not been identified by the provider or registered manager, despite monthly audits having taken place. Audits had not identified quality issues and safeguarding concerns prior to the intervention of outside agencies. However, they had identified that staff had not received formal supervision and training but insufficient action had been taken to address this at the time of our inspection. There was evidence of improvements having been made in accurate record keeping, but further work was still needed.

The provider had increased the numbers of staff on duty in order to help address some of the quality and safeguarding concerns raised by West Sussex County Council (WSCC). As a result there were sufficient numbers of staff to provide safe care. However, staff were not deployed effectively to meet people’s needs. Some people who req

The inspection took place on 10 and 11 October 2016 and was unannounced.

Longfield Manor provides nursing care and can accommodate up to 60 older people with a variety of physical and mental health needs. Fourteen of the beds are within the Rosewood unit, which cares for people living with dementia. There were 54 people in residence at the time of our visit, including 14 in Rosewood.

The service did not have a registered manager. The registered manager had left in September 2016 and was in the process of deregistering. 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. In the absence of a registered manager, the deputy manager was overseeing the service with support from a representative of the provider.

Medicines may not have been consistently administered. We have made a recommendation about reviewing written guidance relating to medicines. This was because information on how specific medicines should be administered was missing or lacked detail. This could have an impact on the consistency of support that people received, especially when temporary staff were involved in administering medicines.

People, relatives and staff spoke of improvements in the service and a reduction in the number of agency staff used. We found, however, that the changes in the staff team and the relatively high use of temporary staff was still impacting on people’s experience. The provider was actively recruiting to the vacant positions and tried wherever possible to use the same members of agency staff to promote continuity.

People told us they felt safe at the service and that staff treated them respectfully. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned someone was at risk of abuse. Risks to people’s safety were assessed and reviewed.

People had developed good relationships with staff and had confidence in their skills and abilities. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training which helped them to improve the care they provided to people.

Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

The home included a dementia community known as ‘Rosewood’. A team leader had been appointed to run this part of the service. They had made improvements to the care and the home environment which was having a positive effect on people’s wellbeing.

People told us the meals at the service were improving and that the new Chef was listening to their feedback and suggestions. Staff monitored people’s weight to ensure they were receiving enough to eat. Where concerns were identified, action had been taken to ensure people had adequate food and fluids.

Staff responded quickly to changes in people’s needs and adapted care and support to suit them. Where appropriate, referrals were made to healthcare professionals, such as the GP or dietician, and advice followed.

People were involved in planning their care but on-going involvement had not always been recorded. The deputy manager was planning to introduce six monthly reviews to ensure that staff actively sought input from people and, where appropriate, their families.

There was an established system in place to monitor and review the quality of care delivered and to make improvements. People, their relatives and staff felt confident to raise issues or concerns. Where improvements had been identified action had been taken or was underway.