We inspected Longwood Grange on 15 and 16 October 2018. Our first inspection day was unannounced.

Longwood Grange is a care home for up to 34 people. At the time of this inspection there were 29 people living at the home (30 on second day). 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. Longwood Grange consists of one building with two floors; communal areas are located in the first floor and bedrooms on the second floor.

Longwood Grange was last inspected on the 21 and 22 December 2016. At that time it was rated requires improvement overall and was in breach of regulations in relation to consent, safe care and treatment, staff’s access to training and supervision, fit and proper people employed and good governance. This was the third time this service was rated required improvement. Following the last inspection, we have served a warning notice on the registered provider and told they had to become compliant with the Regulations by 12 April 2018. At this inspection we found not enough improvements had been made in some of the areas identified and the provider was in continuous breach of regulations related with consent, safe care and treatment, fit and proper people employed and good governance. We also identified two new breaches in relation to person centred care and dignity and respect.

At the time of this inspection the service had a home manager since June 2018 who had not registered to manage the service. The home manager was on annual leave during our inspection visits but the deputy manager and regional support manager were available to provide information. After our visits, we spoke with the home manager to gather more information in relation to some areas of concern. It is a legal requirement that the home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 widespread failings in the oversight, monitoring and management of the service, which meant people did not always receive safe care.

The provider’s compliance with the Mental Capacity Act 2005 was inconsistent. Assessments and best interest decisions for some people living with dementia were in place but we saw relatives giving consent for decisions without having lasting power of attorney. There was no evidence people were being restricted or receiving care that was not in their best interests.

Medicines were not always administered in a safe way. We found medicines were given in a caring way however we could not be certain these were always administered as prescribed and there were no protocols for people who required ‘as and when required’ medication.

Risks to people were not always managed safely. The provider was not checking the temperature of the water before helping people to take a shower or bath therefore putting them at the risk of being scalded. Not all staff had been involved in a fire drill, in particular night staff, so the provider could not evidence staff would be able to safely evacuate people in an event of a fire. Other risks related with people’s care such as their skin integrity, mobility, eating and drinking were being identified, assessed and managed.

The provider was not consistently recording the accidents and incidents that happened at the home or analysing any patterns and trends to prevent them happening again.

We received variable feedback from people, relatives and staff about staffing levels at the home. The home used a dependency tool to assess people’s needs and determine staffing levels however our analysis of the ro

We inspected Longwood Grange on 21 and 22 December 2016. The first day of the inspection was unannounced, which meant the service did not know we were coming.

Longwood Grange was last inspected in November 2015. At that time it was rated as ‘requires improvement’ in all aspects except Caring, which it was rated as ‘good.’

At the time of this inspection, 30 people were living at the home; one of these people was there for respite care.

The home did not have a registered manager. The last registered manager left in June 2016. A new home manager had started work at the home two days before this inspection. Their intention was to apply to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 some aspects of the recruitment process for new staff could not be evidenced by the home.

Risk assessments and care plans did not always contain the level of detail staff needed to support people to move safely. This was also found at our last inspection in November 2015.

We found personal emergency evacuation plans or PEEPs did not contain the level of detail required for staff to support people to evacuate in an emergency. This was identified at our last inspection in November 2015. There had been no fire drills at the home in 2016 and less than half the staff had up to date fire safety training.

Care workers had not always received the training, supervision and appraisal they needed to support people effectively. Issues with access to supervision were noted at our last inspection in November 2015.

People who needed to be deprived of their liberty to keep them safe had the correct authorisations in place. Most mental capacity assessments and best interest decision documentation we saw was not correct. Some people’s care files showed family members had made decisions on their behalf when there was no evidence they had the appropriate powers of attorney.

People told us they enjoyed the food and drinks served in the home. We observed people had access to drinks and snacks, and were provided with choices. Records showed one person was not supported according to a dietician’s advice. People’s food and fluid intake records were not sufficiently detailed to make them useful.

The home could not evidence it had fully investigated and responded to a formal complaint received from a person’s relative in 2016.

By comparing accidents and incidents at the home with notifications made to CQC, we found three instances of physical abuse or threats of physical abuse involving people at the home had not been reported as is required.

A lack of consistent management and leadership at the home in 2016 meant there had been issues with record-keeping, staff access to supervision and the quality of audit.

At the time of this inspection ratings from the last inspection in November 2015 were prominently displayed in the home, but not on the home’s website, as is required by the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2015. We notified the registered provider who told us it had been an oversight when the website had been updated. We saw the ratings were reinstated on the website immediately.

Oral medicines, including controlled drugs, were administered and managed safely. Records for the administration of topical creams and lotions kept in people’s rooms were incomplete.

Accidents and incidents had been investigated, although we identified gaps in documentation and times when interim managers had lacked oversight of incident records.

People and their relatives told us there were enough staff to support people safely and our observations supported this. Some care workers thought there should be mor

This inspection took place on 11 December 2015 and was unannounced. The service had previously been inspected on 23 February 2015 and was not meeting the regulations in relation to the management of medicines, staffing levels and arrangements for acting in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We asked the service to make improvements and the registered provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked to see if improvements had been made. We found significant improvements had been made around medicines management, staffing level and with the application of the Mental Capacity Act Deprivation of Liberty Safeguards. However, we still found gaps relating to capacity assessments and the administration of medicines covertly.

Longwood Grange is a registered care home situation in the village of Longwood, outside Huddersfield. It provides accommodation and personal care for up to 34 people. At the time of our inspection there were 24 people living there. Four people were living with dementia. 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.

We found staffing levels at the service had improved since our last inspection. People told us their call bells were answered in a timely manner and staff responded to their needs.

Staff had received training in safeguarding people from abuse and were able to tell us what they would do if they suspected abuse was happening.

Medicines management and administration had significantly improved since our last inspection but we found an issue with medicines which had been crushed prior to administration which was not in accordance with the guidance provided by the pharmacy and was not safe practice. This was addressed immediately by the registered manager who ordered liquid medicine.

Staff had received regular training to ensure they had the skills to perform in their role. Some staff were supported to undertake courses to attain NVQ relevant to their position.

People's nutritional and hydration needs were well met and people told us they liked the food served at Longwood Grange.

People whose liberty was deprived had been referred to the local authority for an authorisation in accordance with the Mental Capacity Act 2005. However, we found capacity assessments were general and did not always relate to the specific decision to be made. We found medicines had been administered covertly without the lawful authority to do so, on the advice of the GP. The registered manager was to initiate a best interest meeting immediately to ensure this practice was lawful.

Staff were kind, caring and compassionate to the people who lived there and the relationships between staff and the people they supported were observed to be respectful and dignified.

People's independence was actively promoted and the registered manager encouraged people to be part of the local community.

Care records had improved but there were still sections which were incomplete and daily records were repetitive and did not show the daily experience of the person living at the home.

The registered manager ensured there were very few complaints by encouraging relatives to regularly feedback verbally about the service and how they believed it could be improved.

The registered manager had improved the care provided at the home over the previous few months and was aware that improvements in management reports needed to be their next focus. Improvements in the décor and the environment had created a very homely, friendly atmosphere at Longwood Grange. The registered manager and the

We inspected Longwood Grange on 23 February 2015 and the visit was unannounced. Our last inspection took place in July 2014 and , at that time; we found the service was not meeting the regulations relating to care and welfare of people who used the service, management of medicines and effective quality assurance monitoring system. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had not been made in all of the required areas.

Longwood Grange is a registered care home situated in the village of Longwood, three miles outside Huddersfield. It provides accommodation and personal care for up to 34 people. At the time of our inspection there were 12 people living in the home. The home is set in its own grounds and there is ample car parking available.

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.

During our visit we saw people looked well cared for. For example, people were wearing jewellery, had their hair styled and the men shaven. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We believe more staff is required on a night. The home had two staff members on night duty and the support needs of some of some people who used the service necessitate two members of staff with them to ensure their care was met safely. This left others unattended which is a breach of regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The organisation’s staff recruitment and selection procedures are robust which helps to ensure people are cared for by staff suitable to work in the caring professional. In addition all the staff we spoke with were aware of signs and symptoms which may indicate people were being abused and the action they needed to take.

The staff have access to a range of training courses relevant to their roles and responsibilities and are supported to carry out their roles effectively though a planned programme of training and supervision. However these were not always kept up to date.

Medication administration records (MAR) sheets were in place with photographs available as identifiable resource files. However, there was a risk to people’s safety because medicines were not always managed consistently and safely. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s care plans and risk assessments were person centred and the staff we spoke with were able to tell us how individuals preferred their care and support to be delivered. Care plans and risk assessments were reviewed on a regular basis to make sure they provide accurate and up to date information and were fit for purpose.

The registered person did not have suitable arrangements in place for acting in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. This was in breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us the food at the home was good and that they had enough to eat and drink. We observed lunch being served to people and saw that people were given sufficient amounts of food to meet their nutritional needs.

There is an effective quality assurance monitoring system in place which quickly identifies any shortfalls in the service and there are systems in place for staff to learn from any accident, incidents or complaints received.

We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 come into force on 1 April 2015. They replace 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.

Prior to this visit we received information of concern. The concerns were that the needs of people living in the home were not always being met. We also received information of concern in relation to medications, the use of agency staff and safeguarding issues.

We asked our five questions; Is the service caring? Is the service responsive? 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 inspection, speaking with people who lived at the home, staff members, managers and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were some systems in place to ensure managers and staff learned from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. However, we found that there were no written records of audits in the last three months.

We found many areas at the home were unclean and equipment was not always well maintained. However, the local authority infection control team had recently made a visit to the home and implemented an action plan for the home to meet and follow.

We found some issues within the sample of care records we looked at.

Is the service effective?

People’s care records were written with their involvement or with the involvement of relatives and other healthcare professionals.

We found that people’s care records were up to date and contained correct and accurate information.

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People’s preferences, interests, aspirations and diverse needs had been recorded in care records.

Is the service responsive?

People did not partake in many activities at the home. On the day of our visit we observed people sitting in lounges with no interaction from staff members for a considerable length of time. People who lived at the home told us they would like more activities to partake in.

Is the service well-led?

The service had quality assurance systems in place and, where shortfalls were identified, actions were identified. However, we found there had been a lack of audits carried out at the home over the last 3 months. We also found many areas of the home were dirty, though this had not been identified during audits of the environment at the home. We spoke with the manager about this, who told us audits had not been carried out recently due to them being relatively new in post. The manager said they would ensure that audits were carried out regularly.

Staff told us they were clear about their roles and responsibilities. People who lived at the home and staff we spoke with said they felt care staff were ‘stretched’ and did not have a lot of time to carry out their duties.

We asked our five questions; Is the service caring? Is the service responsive? 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 inspection, speaking with people who lived at the home, their relatives, staff members and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff and told us they felt safe.

Systems were in place to ensure managers and staff learned from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw staff members had received training in dementia and creating a dementia friendly environment.

The service was safe, clean and hygienic and equipment was well maintained.

The registered manager set staff rotas, taking people’s care needs into account when making decisions about staff numbers. This helped ensure people’s needs were able to be met.

Is the service effective?

Where possible, people’s care records were assessed with their involvement and with the involvement of relatives and other healthcare professionals

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities at the home. On the day of our visit we observed people watching television, singing and playing musical instruments. People who lived at the home told us they liked to do baking with the kitchen assistant.

People, or relatives of people, knew how to complain if they were unhappy. People we spoke with said the manager was approachable, including staff members. One member of staff we spoke with told us; “It’s good here. A lot of things have changed and staff morale is lots better”.

Is the service well-led?

The service worked well with other agencies and services to make sure people received the most suitable care. This included multi-agency work with the local authority and Care Quality Commission.

The service had quality assurance systems in place and, where shortfalls were identified, actions were identified. We found some issues with the completion of audits, where actions hadn’t been signed off when completed. We spoke with the manager about this and they told us they would ensure that this would be put into practice.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. Staff were also aware of audits and observations carried out by the manager to monitor and improve service provision. This helped to ensure people received a good quality service.

We found some issues with staff members not recording people’s personal care in care files.

We also found some issues with Disclosure and Barring Service (DBS) checks being out of date. We spoke with the manager about this. The manager told us they had been in post since October 2013 and had only just been made aware that some DBS checks were out of date. We saw evidence that the manager was taking appropriate action to remedy this issue.

When we visited the service on 4 April 2013 we found there was a lack of evidence that people living at the home were protected from the risk of abuse. This was because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We asked the provider to make improvements. We went back on this visit to see whether improvements had been made.

On the day of our visit there were six people living at Longwood Grange. During our visit we spoke with the manager and five members of staff. One of the people living at the home had been admitted on the day of our inspection and the other five people living at the home had lived there for at least 12 months.

The manager explained they had taken up the position home manager on 3 June 2013, following the resignation of the previous registered manager. At the time of our inspection the new manager told us they were in the process of applying to become the registered manager.

During our visit we spoke with two care staff about safeguarding and abuse. Following our visit we spoke with a further three care staff. The care staff we spoke with told us they were pleased there was a permanent manager in post. Staff told us they did safeguarding training annually using e-learning. Three of the five staff we spoke with told us their training was currently out of date.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

On the day of our visit there were five people living at Longwood Grange. During our visit we spoke with the temporary manager, two people who lived in the home, a relative and two members of staff.

The two people we spoke with told us the food was good and they always got a choice. They told us they felt safe living at the home and had never needed to make a complaint. One person said “I have a nice bedroom and you can bring their own things”. When we asked them about the staff they told us the staff were helpful, kind, and friendly. One person said “Its okay here and the staff are alright”. One person liked reading and told us there were always plenty of books available. They said “I’m quite contented here”.

The relative we spoke said “I’m always impressed; the staff are willing to go the extra mile. They are really caring and I am very happy with the care provided”.

The two staff we spoke with told us they felt confident the care provided at the home was good and that they had a good team. One of them told us “It’s a nice home in a nice area and staff know all the residents really well. Staff all care about the residents”. They told us they felt well-supported by the new temporary manager.

We spoke with five people who live at Longwood Grange. They all told us they were happy with the quality of care they received. One person told us that they are quite independent and required little support from the care staff. Another person told us, “It’s a good place here.”

The people we spoke with told us that they had plenty to do and had the opportunity to go out. One person told us, “We go out if we want”.