Langbury House

Langbury House is a residential care home providing personal care to four young people with learning disabilities and/or autism. The service can support up to five people. The service was a semi-detached bungalow with a garden, in a small coastal village. People had their own bedrooms and bathrooms. There were shared eating and living areas.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. There were enough staff to meet people’s needs. People’s medicine support was being managed safely. The service was clean and hygienic. There were safe recruitment practices.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

Staff did not always communicate or support people in dignified or respectful ways. Improvements were needed to make sure people were involved and included in a personalised way when being supported by staff. Professionals who worked with staff and relatives of people at the service gave us mixed feedback about the quality and safety of the support people received.

People and their relatives gave us mixed feedback about how involved and engaged they were with planning their support or developing the service, to help them achieve good outcomes.

Right Culture:

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Internal quality assurance systems and processes to maintain and develop the safety and quality of care were not always operating effectively. Staff and relatives told us some aspects of the culture and leadership of the service required improvement to ensure people achieved good outcomes from their support. Staff, relatives and management told us on-going staffing turnover and vacancies at the service were impacting on staff morale and performance.

The provider was aware of and were committed to providing resources to make any necessary improvements as quickly as possible. Staff equality and diversity was respected and promoted at the service and within the provider’s organisation.

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 21 April 2021).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

We received concerns in relation to staffing, uncaring support and people not being kept safe from abuse and improper treatment. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only. 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. We have found evidence that the provider needs to make improvement. Please see the safe, caring 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.

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

Enforcement and Recommendations

We have identified breaches in relation to dignity and respect, risk management, abuse, and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Langbury House is a residential care home providing accommodation and personal care for up to five adults with complex learning disabilities, autistic spectrum conditions and a variety of associated health and support needs. At the time of the inspection there were four people living at the service.

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

People's privacy, dignity and confidentiality were respected by caring staff. Staff listened to people and communicated with them in the most accessible way.

People were encouraged to be as independent as possible and staff spoke proudly of people’s achievements.

People told us they felt safe with staff. A person told us they liked all the staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Risk assessments were carried out to make sure people received their care safely and had opportunities to take part in activities which interested them and promoted their independence.

Medicines were managed safely, and staff had a good knowledge of the medicine systems and procedures. Staff had received training and had competency assessments of their practice.

There were adequate numbers of staff to meet people's needs.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and Independence. The service follows the social model of support; for example, minimising barriers to inclusion by having high/low worktops and sink in the kitchen so people can participate in the routines of the house.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. The registered manager and staff knew people well, each person had support unique to them.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. People were spoken to with equity by staff and their consent and views were sought.

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

Rating at last inspection

This service was registered with us on 23 May 2019 and this is the first inspection.

Why we inspected

This was a planned first inspection following registration with the Care Quality Commission (CQC).

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.

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.