Archived: Langdale Heights

We carried out an unannounced comprehensive inspection of this service on 31 May and 3 June 2016. Five breaches of legal requirements were found. This was because the provider had not minimised the risks to the people’s health and safety, protected people from abuse and improper treatment, supported and trained staff, ensured care was designed to achieve people’s preferences and meet their needs, and monitored and improved the quality and safety of the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. At this inspection we found that action had been taken and all breaches had been met.

Langdale Heights has 31 beds and provides residential and nursing care to older people, some of whom are living with dementia and/or physical disabilities. It is has 27 single rooms and two double rooms. At the time of our inspection there were 26 people using the service.

The service had a registered manager. This 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 said the friendly staff and the company of others made them feel safe at Langdale Heights.

Staff had a good understanding of their responsibilities to protect people from harm and knew who to contact if they had any concerns about a person’s well-being.

People gave us examples of how staff reduced risk. One person said staff made them feel safe at bedtime by putting safety rails on their bed so they didn’t fall out. Another person said staff had told them not to walk on their own in case they fell. Staff had the information they needed to help keep people safe. Medicines were safely managed and given to people when they needed them.

People told us there were enough staff employed to give them support when they needed it. Call bells were answered promptly and people didn’t have to wait long for staff to assist them. Records showed the staff employed were suitable and safe to work with people using care services.

People told us the staff were well-trained and knew what to do if someone needed support. We observed staff providing people with effective care using their skills and knowledge. For example, we saw staff assist people to move safely, ensure their dietary needs were met, and give reassurance when people needed it.

People told us they could choose what they wanted to do at the service, for example what time they got up in the morning and where they wanted to spend their day, and staff respected their choices. We saw that staff always sought people’s permission before providing them with any care.

People had mixed views about the food served. Some said they enjoyed it while others said they would like more variety. Between meals staff brought round a trolley with a wide range of drinks and snacks on it including tea and coffee, fruit juice, and cakes and biscuits. This was popular with people who enjoyed choosing things from the trolley.

Staff supported people to maintain good health and access healthcare services in the local community when they needed to. The nurses we spoke with mostly had a good understanding of people’s healthcare needs and when to refer them for specialist support.

People told us the staff were friendly, caring, compassionate, and willing. We saw staff reassure people when they needed it. When one person became distressed a staff member sat and talked with them and stroked their hand until they felt better. A staff member gave another person a hug as they said they were feeling a bit sad.

The staff we spoke with were aware of people’s preferences and interests. For example, they knew people’s favourite songs and sang them, with the people in question joining in. They respected people’s choices, for example some people liked to go to their rooms for a nap or to watch television after lunch and staff supported them to do this.

People told us they received care and support that was right for them. The care records we saw were personalised and included information about people’s chosen lifestyles, choices and preferences.

People had mixed views about the activities provided. Some were satisfied with them but others said they would like more to do. The registered manager was addressing this and said new staff were in the process of being recruited.

The atmosphere at the service was positive and upbeat. People were comfortable and happy to share their views on the service, as were the staff. We noted many improvements including the redecoration of the premises, a high standard of cleanliness throughout, and further staff training in proving personalised care. The provider had systems in place to quality assure the service and to help ensure high quality care was being provided.

Langdale Heights has 31 beds and provides residential and nursing care to older people, some of whom are living with dementia and/or physical disabilities. It is has 27 single rooms and two double rooms. At the time of our inspection there were 25 people using the service.

The service has a registered manager. This 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 using the service told us they had not always felt safe at Langdale Heights. Staff had failed to follow the providers’ safeguarding procedures and had not always reported safeguarding incidents to the relevant authorities. People did not always have appropriate risk assessments in place to help ensure they remained safe at the service.

During our inspection visits there were sufficient staff on duty to support the people using the service in a timely manner. However, some people felt there was a delay in personal care being provided on occasions.

Staff were safely recruited. Staff training had not always been effective and there were gaps in the providers’ staff training programme and supervision schedule.

People using the service told us they were satisfied with the food provided. People had a choice of dishes at each meal. The food served was well-presented and looked appetising. If people needed assistance with their meals staff provided this on a one-to-one basis.

People had access to a range of healthcare professionals including the nurses employed, GPs, mental health practitioners, district nurses, chiropodists, opticians, and dentists. However people had not always been referred to the appropriate healthcare services for treatment and people’s healthcare needs had not always been planned for. Medicines were safely managed and administered in the way people wanted them.

People using the service and relatives told us the staff were caring and kind. We observed that staff spent time sitting and talking with people. We heard them speaking kindly to people while they supported them and reassuring people when they needed this. Improvements were needed to how people were supported to express their views and to how their privacy and dignity was maintained.

People’s needs were assessed prior to them coming to the service but these had not always been taken into account when staff planned their care and support. Some activities were provided at the service but people said they would like a wider range of activities to choose from.

Some equipment and areas of the premises were in need of a deep clean and we found issues with health and safety at the premises. Improvements were needed to the way the registered persons implemented the Mental Capacity Act 2005. This was because staff were unclear as to the criteria for referring people to the Deprivation of Liberty Safeguards team.

When we carried out our first inspection visit the registered manager was not at the service. People using the service and staff told us they were unsure about whether she was still working there. On our second inspection the registered manager was back full-time at the service.

Between our two inspection visits, and in response to the concerns we raised, the providers carried out a number of improvements to the service.

We found breaches 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 the report.

We observed interactions between staff and people who used the service during the lunchtime period. We saw that people were assisted appropriately by staff and that interactions were positive. We saw that care plans of people using the service were person centred and contained appropriate information of people's needs.

The provider had implemented weekly and quarterly audits to ensure that the home was appropriately cleaned. We saw that all areas inspected were cleaned to a good standard.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that staff received appropriate training to enable them to carry out their role. We also saw that staff received regular supervision and support from the provider.

The provider had systems in place to deal with comments and complaints. People who used the service were given information about how to make a complaint if they needed to.

People who used the service told us that they understood the care, treatment and support choices that were available to them. The people who used the service all provided positive comments about the home. A person we spoke to said that their relative 'had only been given around two months to live by doctors. She then came here and has been here for nearly three years, so that says something about the care she has had'.

The provider has effective recruitment and selection procedures in place and carries out relevant checks when they employ staff and has enough staff who knew the needs of the people using the service.

The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service. This shows that the provider was reducing the risks identified in order to prevent the service becoming non-compliant with the regulations.

We noticed that a number of areas were not clean within the home as well as identifying black mould. The provider was not maintaining a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.