This comprehensive inspection took place on 24 and 25 September 2018; the first day of the inspection was unannounced.

Longfield Residential Home - MD (referred to throughout the report as Longfield) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 provides accommodation and personal care for up to 24 older people. The service specialises in providing care for people living with a dementia. There were 20 people using the service at the time of this inspection. The home is in a residential area close to Blackburn town centre and local amenities.

There was a registered manager in place. 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. As the registered manager was also registered to manage the provider's sister home a short distance away, they were supported in the running of Longfield by a deputy manager. This ensured there was management cover in the home seven days a week.

At the last inspection in July 2016, the service was rated as good. At this inspection, the rating has improved to outstanding; this was due to the excellent way in which the service was led and the commitment from staff to deliver high quality, compassionate care.

People received care which recognised their individual differences and respected their right to be treated with dignity and respect. Feedback from relatives was extremely positive. They told us staff regularly went the ‘extra mile’ to provide their family members with person-centred care and to ensure people felt they mattered to them. Our observations throughout the inspection, showed the home was filled with laughter and music and that staff interacted with people in a caring and respectful manner.

The registered manager was creative in developing training which encouraged staff to put themselves in the shoes of the people they supported; the aim of this was to help ensure staff always treated people with the utmost dignity and respect. Staff and relatives told us this training had made a positive difference to the care people received.

Staff had an excellent understanding of people’s diverse needs and preferences. Staff used memory books and information about people’s social histories to regularly engage them in conversations and discussions to promote their sense of well-being.

The registered manager was committed to ensuring people always received high quality care in Longfield. They led by example, setting high standards for staff and used information from best practice guidance, their own research and learning from accidents, incidents and complaints to make improvements in the home. Quality assurance systems implemented by both the provider and registered manager were robust and used to ensure the quality and safety of the service.

Without exception, staff told us Longfield was an excellent place to work. They told us the registered manager encouraged them to make suggestions about how the service could be improved and was willing to try things out to see if they enhanced people’s experience in the home. People were encouraged to provide feedback on the care provided in Longfield. Responses received were used to make any required improvements. Action taken in response to feedback was clearly displayed in the reception area of the home.

People living in the home told us they felt safe and staff treated them well. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home. There were sufficient numbers of staff to m

This was an unannounced inspection which took place on 2 June 2016. We had previously inspected the service in June 2014 when we found it to be meeting all the regulations we reviewed at that time.

Longfield Residential Home is registered to provide accommodation for up to 24 older people who have a mental disorder or are living with a dementia. At the time of this inspection there were 20 people living at the home.

There was a registered manager in place at the service. 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.

People who used the service and their relatives did not express any concerns regarding the care provided at Longfield. Staff had completed training in safeguarding adults and knew the correct action to take should they witness or suspect abuse. We were told that staff had been confident to report poor practice they had observed to the registered manager who had taken appropriate action to ensure the high standards they expected were understood and met by all staff.

Robust recruitment systems were in place to help protect people from the risk of unsuitable staff. The registered manager regularly checked that staffing levels were sufficient to meet people’s needs. All the staff we spoke with told us they had enough time to spend with people; this was confirmed by our observations during the inspection.

Appropriate arrangements were in place to help ensure the safe handling of medicines by staff. The registered manager completed regular medication audits and checked staff were correctly following policies and procedures regarding the administration of medicines.

All areas of the home were clean and we saw that procedures were in place to prevent and control the spread of infection. Risk assessments were in place for the safety of the premises and systems were in place to deal with any emergency that could affect the provision of care.

We saw that the equipment and services within the home were serviced and maintained in accordance with the manufacturers' instructions. This helped to ensure the safety and wellbeing of everybody living, working and visiting the home. Improvements had been made to the environment to help promote the independence of people living with a dementia.

Staff had received induction, training and supervision to help ensure they were able to deliver effective care. All staff had completed or were working towards a nationally recognised qualification in care.

Arrangements were in place to ensure people’s rights and choices were protected when they were unable to consent to their care and treatment at the home. Staff had received training in, and understood, the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA.

Systems were in place to help ensure people’s health and nutritional needs were met. People made positive comments about the food provided at Longfield. During the inspection we observed meals were well presented and nutritionally balanced. Staff provided individual support to people who required assistance to eat.

All the people we spoke with during the inspection spoke positively about the caring nature of staff. Our observations showed staff were caring and respectful in all their interactions with people who used the service. All staff took time to help ensure people felt cared for and listened to.

People's care records contained detailed information to guide staff on the care and support required. Care records showed that risks to people's health and well-being had been identified and regularly reviewed. All the staff we spoke with had a good understanding of the care and support that peop

The inspection team included an inspector and an expert by experience. The team gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive to people’s needs? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the visit, speaking with eight people who used the service and five relatives. We also spoke with three staff and looked at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with eight people who used the service. They told us they felt safe in Longfield and were happy with the care provided. One person explained to us they felt independent but safe within the home and any limits to their full independence were always discussed with them. Another person told us they considered staff were always gentle and careful when helping people.

Care records provided staff with good information about the individual needs of people. Information included areas of risk and what staff would need to do to keep people safe.

Recruitment processes were in place to protect people who used the service from the risk of unsuitable staff.

Systems and processes were in place to assess and manage the risks related to the use of equipment in the home. Staff had appropriate training to be able to support people to move safely around the home.

Systems were in place to record and review complaints, accidents and incidents. This should help reduce the risk to people and help the service to continually improve.

Is the service effective?

People were assessed by a senior member of staff from the home before they were admitted to ensure their individual needs could be met.

To ensure that safe and effective care was provided, staff continued to update their skills and knowledge with regular training and updates.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. Risk assessments were regularly reviewed and care plans amended to reflect people’s changing needs.

Is the service caring?

People we spoke with made complimentary comments about the staff team. Comments included, “They [the staff] can’t do enough for you; you just have to ask” and “The staff are very nice and friendly to me”.

It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs.

Is the service responsive to people’s needs?

People who used the service were offered regular opportunities to comment on the care and support they received.

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people who used the service.

People knew how to make a complaint and were confident any concerns they raised would be dealt with by the home manager.

Systems were in place to ensure staff had access to up to date information regarding people’s needs. This should help ensure they were supported to respond appropriately to any changes to a person’s condition.

Is the service well-led?

The home had a manager who was registered with the Care Quality Commission and was qualified to undertake the role.

Quality assurance processes were in place in the home. Records we looked at showed us people had recently completed a satisfaction survey. The results of the most recent survey in November 2013 confirmed people were very happy with the care provided.

Regular meetings were held with staff. These provided the opportunity for staff to discuss any concerns or practice issues in the home. Staff told us they enjoyed working in Longfield and felt well supported by the manager and senior staff.

We spoke with four people who used the service and two visitors to the home. All the people we spoke with told us they felt the quality of care provided at Longfield was good. Comments included, “I’m a lot younger than other residents and staff treat me accordingly. Staff take me to hospital appointments and occasionally to visit an aunt” and “I keep myself to myself. I’m happy on my own. If I need any help the girls will always come”.

We reviewed the care files held for six people who used the service. We found care plans clearly identified the needs of the person and included information on their wishes and preferences in relation to the support they required.

People told us they enjoyed the food served at the home. One person commented, "I like the lunches and the teas here. I can choose where I sit. I enjoy the meals and we get plenty to drink”.

People who used the service told us they felt safe and were confident in the abilities of staff to meet their needs. We found staff had received training on safeguarding vulnerable adults and had access to relevant policies and procedures.

We found there were sufficient numbers of staff on duty to meet the needs of people in Longfield. However, two people told us they felt there should be more staff available at times.

We found suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints for people living in Longfield.

We spoke with four people who use the service as well as a relative. All the people spoken with told us they were happy living in the home and that the staff were kind and caring. One person told us "It's great here. The staff are very helpful".

We spoke with three members of staff who told us they felt well supported and confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified and provided with training relevant to their role.

We reviewed the care files of three people using the service and found evidence that there were procedures in place to ensure that consent was gained from the person or their representative in relation to the care provided for them. We saw that care plans clearly identified the needs of the person and included information on how they wished their care to be delivered. One person told us that "Staff know what you like and what you don't like very quickly".

We saw that people considering admission to the home were provided with information about the level of fees payable and how these were calculated.

People spoken with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We found that there were effective systems in place for the completion and storage of records relating to the care of people using the service and the maintenance of the premises.

Due to the nature of the service provided we were unable to obtain the views of the people who used the service. However, one person was able to tell us that he was very happy at the home and staff were kind to him.

Relatives were able to air their views of the service in a recent survey. The results showed us that:

People who used the service were offered choice.

People were supported by sufficient numbers of well trained staff.

The food was nutritious and tasty.

The home was warm, clean and smelled pleasant.

Leisure activities were encouraged and staff helped people who used the service attend them.

People who used the service had choices within the daily routine and personal care was carried out privately.

Staff welcomed them into the home and passed on relevant information to keep them up to date with care needs.