Archived: Langdale Residential Home

Langdale Residential Home is a residential care home providing personal care for people aged 65 and over. The care home accommodates 19 people in one adapted building. At the time of the inspection there were 17 people living at the home.

People’s experience of using this service and what we found

Some improvements were needed to make sure people were safe. Risk assessments needed to be in place to make sure all risks to people’s health and safety were managed.

We were not assured that systems were in place and guidance being followed to minimise the risk of spread of infection within the home.

Improvements were needed to make sure medicines were stored safely.

We have made a recommendation the provider puts a system in place to make sure medicines are stored at temperatures recommended by the manufacturer.

Recruitment was managed safely. The staff team were consistent and experienced and had the skills to support people safely. Some people told us they thought more staff were needed and rotas showed days when only three staff were on duty.

We have made a recommendation the provider reviews staffing arrangements to make sure they are sufficient to meet people’s needs.

The home needed some refurbishment and the garden needed to be cleared of rubbish to provide a safe space for people to enjoy.

People who used the service, relatives and staff provided good feedback about their experience. People said they felt safe and staff were caring and kind.

Systems to monitor and check the service were in place but these needed to be more thorough to identify the issues we highlighted during this inspection.

There was a lack of oversight of the quality and safety of the service by the provider. We have made a recommendation they establish systems and processes to ensure they have effective and regular oversight of the quality and safety of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 November 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langdale Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of regulations 12 (Safe Care and Treatment) in relation to infection prevention and control and 17 (Good Governance).

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The last inspection was in October 2016 and the service was rated ‘requires improvement’ overall. We found one breach of regulation in relation to Good Governance (Regulation 17). At this inspection we found improvements had been made with better documentation kept. For example in relation to the management of medicines.

A registered manager was in post who had worked at the home for a number of years. 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 and relatives spoke positively about the home. They said good quality care was provided. People said the staff team were friendly and kind and the registered manager was approachable.

Medicines were managed safely. People received their medicines as prescribed and clear records were kept demonstrating the support people had been provided with.

People said they felt safe. Safeguarding procedures had been followed to help protect people from harm. Risks to people’s health and safety were assessed and measures put in place to keep people safe. These measures were regularly reviewed.

The premises were safely managed with appropriate checks undertaken to the building. The décor in some areas of the building was tired and would benefit from decoration.

There were enough staff deployed to ensure safe and prompt care. The staff team were seen to respond quickly to people’s requests for assistance. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

People praised the staff who supported them. Staff received a range of training and support to give them the skills to do their role effectively. This included regular supervision.

People had access to a suitable choice of food. Nutritional risks were assessed and measures put in place to protect people from harm.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

The service worked with a range of health professionals to help ensure people’s healthcare needs were met.

Staff treated people with kindness, compassion, dignity and respect. People were listened to and there was a friendly atmosphere within the home. Where possible, people’s independence was promoted.

People’s care needs were assessed and used to formulate detailed and person centred plans of care. These reflected people’s needs and preferences. Staff knew people well and their plans of care which gave us assurance they were consistently followed.

An activities co-ordinator was employed who worked at the home five days a week, and provided people with a range of activities and social opportunities.

People and staff praised the way the home was run. They described it as personalised and friendly and said the registered manager dealt with any issues that arose. We saw the staff team worked well together.

Audits and checks were undertaken by the management team to monitor how the service was performing. People’s feedback was sought and used to make improvements to the service.

The inspection took place on 5 October 2016 and was unannounced. On the day of the inspection there were 18 people living in the home.

A registered manager was 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.

At this inspection we checked whether improvements had been made to the service since the last inspection in October 2015 where we found a breach of regulation and rated the provider as ‘Requires Improvement’ overall. We found some improvements had been made but areas remained that required attention. Overall, medicines were managed in a safe way with people receiving their medicines as prescribed. However recording arrangements were not consistently robust.

People and relatives spoke positively about the service and said it provided good quality care in a personalised and friendly way. We observed a positive and inclusive atmosphere within the home with people and staff getting on well.

Risks to people’s health and safety were assessed and appropriate plans of care put in place. We found the building to be homely and appropriate for people’s individual needs. Safety features were installed in the building to help keep people safe. We identified one concern with regards to fire safety which we referred to the Fire Service.

There were sufficient staff deployed to ensure safe care and treatment. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

People told us they felt safe using the service. Safeguarding procedures were in place which were understood by staff and the manager.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People said staff had the correct skills and knowledge to provide effective care. Staff received a range of training, supervision and support from the management team.

People praised the food provided by the home. There was sufficient choice and a person centred approach to mealtimes. People’s nutritional needs were met by the service.

People’s healthcare needs were assessed and met by the service in conjunction with a team of health professionals.

People and relatives said staff were always kind and caring and treated them well. Staff demonstrated a good understanding of the people they were caring for. Information on people’s lives had been sought to help staff provide individualised care.

People’s care needs were assessed and person centred plans of care put in place which were well understood by staff.

An activities co-ordinator was employed who provided people with a range of group and individualised activities and outings.

A system to log and respond to complaints was in place. People and relatives were highly satisfied with the service provided.

Systems to assess, monitor and improve the service were in place but these were not sufficiently robust, particularly in regards to medicine management and care records. We found some inaccuracies in care plan documentation which should have been identified and rectified through a programme of audit.

Systems to seek feedback from people who used the service were in place. People said they felt listened to and valued by the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. You can see what action we asked the provider to take at the back of this report.

Is the service safe?

All the medicines people needed were available in the home. We saw that staff administered medicines in a safe, friendly way and respected people's choices. Clear records about medicines were kept to ensure people's safety. Medicines were disposed of appropriately; however disposal records in the controlled drugs register were not completed properly. A few medicines were not stored securely, allowing the possibility of mishandling or misuse.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Safe

We found the home was clean, and free of unpleasant odours.

In the care records we looked at we saw people had risk assessments which covered areas of potential risk such as malnutrition, pressure ulcers and falls. When people were identified as being at risk, their plans showed the actions required to manage these risks.

There were procedures in place to guide staff on the actions to take in response to medical emergencies.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and was aware of the recent Supreme Court judgment on the Deprivation of Liberty Safeguards.

The provider had policies and procedures which related to the safeguarding of people who used the service. Staff had received training on safeguarding and were aware of the different types of abuse which people could experience. They were aware of how to report any concerns they might have about people's safety and welfare. They said they felt confident the management team would address any concerns they raised about people's safety and welfare. However, they were aware of the external agencies they could contact should it be necessary.

The people we spoke with told us they felt safe at Langdale and people's relatives told us they had no concerns about people's safety and welfare.

Effective

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

The home had good working relationships with other healthcare professionals and worked closely with them to make sure people's needs were met. The input of other healthcare professionals involved in people's care and treatment was recorded in their care records.

Caring

One person who used the service told us 'We are well looked after here'. We spoke with the relatives of two people who used the service and they told us they had no concerns about the care provided. One said 'The care is good and the staff are kind, we like it because it is small and homely'.

Another relative said they had seen a great improvement in their relative since they moved into Langdale. They said their relative was taking more of an interest in life and was enjoying having their hair and nails done. Both people's relatives told us they were kept informed and one said the staff were very good at explaining things to them.

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Responsive

People's needs were assessed before they moved into the home. We saw people's care records had information about people's individual needs and preferences.

People told us there were activities for people who lived in the home however, one of the relatives we spoke with said they did not think there was as much entertainment for people as there used to be.

People's relatives told us there were no restrictions on visiting and said they were always made welcome.

Well led

People told us the manager was approachable and listened to what they had to say. They said they would not hesitate to talk to the manager if they had any concerns and were confident their concerns would be dealt with.

The staff we spoke with said they enjoyed working at the home. They said they worked well as a team and felt supported by the management.

As part of the quality assurance monitoring process the service sent out survey questionnaires to people who used the service and/or their relatives to seek their views about the care and support they received. This gave people the opportunity to air their views and opinions of the service.

We found provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. We have asked the provider to tell us what action they are going to take to improve this aspect of the service.

We spoke with two people who lived at the home. They told us they received support at the times they needed it. One person said 'I am happy and comfortable here, I have everything I need'. Another person said 'I don't have to wait for anything, I just have to ask staff and I get the help I need'.

People told us they they were treated with respect and felt safe living at Langdale Residential Home. One person said staff were 'patient and supportive' another person said staff were 'kind and polite'.

We spoke with two relatives of people who lived at the home, they told us they were happy with the care and support provided. One person said staff were 'friendly and like family'. Another person told us staff 'know what my relative's needs are and how to support them'.

We spoke with the community matron who said they visited the home most days. They told us they had no concerns about people's care and welfare and staff were 'very knowledgeable' about people's needs and always followed their advice and guidance.

One person who completed a survey about the service in July 2012 said their relative was 'settled and happy' living at Langdale Residential Home. Another person said there was a 'nice atmosphere and caring staff'. We spoke with one relative of someone who lived at the home, they were very pleased with the care provided by staff and had no complaints.

Despite the positive comments people made. We found evidence care was not planned and delivered in a way that ensured peoples' safety and welfare. We also found people were not always protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We also found staff had not received appropriate training and support to ensure they could meet the complex care needs of people who lived at the home.