Archived: 55 Langaton Lane

55 Langaton Lane provides care and accommodation for up to four people. On the day of our inspection there were four people living at the service. The home provides residential care for people with a learning disability.

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.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

There was a registered manager in post. 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 on the 13 and 14 April 2016, the service was rated Good. However, it was rated Requires Improvement in Well led. The service has now improved to Good in Well Led. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good:

People were not able to verbalise their views therefore they were not able to tell us verbally about their experience of living there. Therefore, we spent time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. This helped us gain a better understanding of people and the care they received at the service.

People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff were recruited safely and checks carried out with the Disclosure and Barring Service (DBS) ensured they were suitable to work with vulnerable adults. Staff agreed that there were sufficient numbers of staff to meet people’s needs and help to keep them safe.

People had their risks assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.

People had their medicines managed safely. People continued to receive their medicines in a way they preferred. Staff completed regular training and competency checks to ensure their knowledge and their skills in relation to medicines, were up to date and in line with best practice.

People were supported by staff who had received training to meet their needs effectively. Staff said meetings, one to one supervision of staff practice, and appraisals of performance were regular completed. Staff, new to care, completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the equality and diversity and the human right needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's health and wellbeing was monitored by the staff and they had access to a variety of healthcare professionals. The registered manager worked closely with external health and social care professionals to help ensure a coordinate approach to people’s care.

People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; taking into account people’s preferences and wishes. Overall, people’s individual equality and diversity preferences were known and respected. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. Staff had built strong relationships with people who lived there. Staff respected people’s privacy. People, or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs. The registered manager had taken account of and acted on the Accessible Information Standard (AIS). The AIS is a requirement to help ensure people with a disability or sensory loss are given information they can understand, and the communication support they need.

Staff adapted their communication methods dependent upon people’s needs, for example using simple questions, pictures and objects. Information for people could have information available about the service in an easy read version or other appropriate format as needed.

People could make choices about their day to day lives. The provider had a complaints policy in place and that was also available in an easy read version. People currently living in the service were unable to make complaints. However, staff knew people well and used this knowledge to gauge how people were feeling. They would then act to ensure people’s concerns were addressed.

The service improved to well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager, appointed six months ago, was approachable and made themselves available. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

Further information is in the detailed findings below

The service provides accommodation and personal care for up to four adults with physical and/or learning disabilities. On the day of this inspection there were two people living there. The service was last inspected on 11 May and 2 June 2015. At that inspection we found the service was not well managed. At this inspection we found the management of the service had improved and the service was fully compliant, although we have recommended improvements are made to the provider's quality monitoring and improvements systems. There was a registered manager in post who also managed another two care homes on behalf of Regents Park Limited. 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.

The people living at 55 Langaton Lane had limited verbal communication skills and were unable to answer questions about the service. Therefore we relied on our observations of their interaction with the registered manager and a care worker during out visit. They were relaxed and smiling and appeared comfortable in all interactions with the registered manager and care worker.

The provider had introduced new quality monitoring systems since the last inspection to ensure the home ran smoothly and to identify where improvements were needed. We saw many examples of improvements to the service, such as care plans, and staff training. However, the monitoring systems were not fully embedded and needed further adjustment to ensure the provider is pro-active in identifying and addressing all issues promptly. We found some areas where further improvements were needed, for example, assessment of dependency levels to determine safe staffing levels.

Recent staff rotas indicated there had been at least two occasions recently when only one member of staff had been on duty during waking hours. The provider did not have procedures in place to measure the dependency levels of the people living in the home. This meant they were unable to identify the safe level of staffing needed to ensure the two people’s support needs were met safely. We have been given firm assurances there will always be sufficient staff on duty in the future.

New staff were recruited by the provider through their head office for the three care homes and one day centre they operated. Checks and references had been carried out before new staff began working with people. The registered manager interviewed and appointed staff. We were given verbal reassurance that a risk assessment procedure was followed where recruitment checks identified issues that may indicate the applicant was unsuitable. However, this had not been recorded.

Medicines were stored and administered safely.

The registered manager and staff showed caring and understanding of each person’s individual needs. They had an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted where relevant. Staff understood the importance of seeking consent before carrying out care tasks. We observed a member of staff seeking consent from people before carrying out any tasks for people.

People had been involved and consulted in drawing up and agreeing a plan of their support needs. Their care plans were comprehensive, well laid out and easy to read. The care plans explained each person’s daily routines and how they wanted staff to support them. The plans were regularly reviewed and updated. The care plans and daily notes provided evidence to show that people were supported to maintain good health.

Staff had received training, supervision and support to enable them to effectively support each person’s mental and physical health needs. New staff received thorough induction training before they began working with people. All staff received ongoing training on topics covering all aspects of their jobs.

The home was well maintained, clean, warm and comfortable. Building works had been carried out in 2015 to create new bedroom and living space on the first floor. At the time of this inspection alterations were being made to the living room to create a sensory area.

On weekdays the two people attended a day centre where they were able to participate in a range of activities such as cooking, gardening, arts and crafts and animal care. When they were at home they were offered a choice of activities including shopping trips and outings.

There were three people living in the home at the time of our inspection. People appeared comfortable whether in the kitchen/diner, in the garden or in their rooms. We saw that staff had a good knowledge of peoples' needs. Staff were heard to address people by their preferred names and were polite and respectful at all times. They checked that people were happy to do things before supporting them.

We saw that people were safe in the home and their care and welfare was managed in accordance with their care plans. Staff were knowledgeable about the needs of people and the abilities they had. They were appropriately skilled and received regular support and development. Peoples' safety was assessed and supported in accordance with risk assessments and the provider's safeguarding vulnerable adults policy.

There were improved systems in place to routinely monitor the quality of service provided and the environment it was provided from.