Archived: Langdale House Care Home

At our last comprehensive inspection on 30 November 2016, we rated the service as requires improvement. The service was rated as requiring improvement in the Responsive and Well-led domains. This was because care plans were not always current and up to date, systems in place to monitor the service were not accurate and people sometimes had to wait for care.

At this inspection we found the service remained requires improvement. This is the third time the service has been rated as requires improvement.

The inspection took place on the 6 March 2018 and was unannounced.

A registered manager was not in post at the time of the inspection. 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. There was a manager in place. The manager told us they would be applying to become the registered manager.

Risks to people were assessed and monitored regularly. However, the information included in the assessment was not always based on guidance from a health professional.

People were not always protected from the risk of infection. The premises were not maintained and presented a risk to people who used the service.

Staff were not always appropriately recruited. Checks to ensure they were suitable to work with people had not always been completed before they started work.

The quality of the service was monitored through limited audits carried out by the management team and provider. These had not been effective at identifying the areas of concern we found.

People felt safe when they were receiving care from staff. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

There was clear guidance for staff about how to support a person if they became aggressive.

There were sufficient staff to meet people’s needs. Although people sometimes had to wait for staff support if the staff did not hear them calling for assistance.

People were supported to take their medicines as prescribed. Staff who administered medicines had not always received training to ensure they were competent.

People's health and well-being was monitored by staff and they were supported to access health professionals.

People were cared for by a staff team who were friendly, caring and compassionate. Positive relationships had been developed between people and staff. People were treated with kindness.

People's care and support needs were monitored and reviewed to ensure care was provided in the way they needed. People had been involved in planning their care.

Plans of care were in place to guide staff in delivering consistent care and support in line with people’s personal preferences and choices. These were being reviewed and updated, however did not always reflect people's current needs or up to date guidance. End of life wishes were discussed and plans put in place.

Staff did not always have access to the supervision and training they required to work effectively in their roles. The manager told us they were working to develop more detailed staff training. People were supported to maintain good health and nutrition.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. There were limited activities available for people. Family and friends were welcomed to visit.

The service was run by a manager who had only recently started their role on a full time basis. They planned to review the service and identify areas for improvement. They had not done this at the time of our inspection. The service aimed to develop a positive ethos and an open culture.

People knew how to raise a concern or make a complaint and the provider had systems to manage any complaints they received.

We found three 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.

Langdale House provides accommodation for younger adults. There were nine people receiving care at the home at the time of our visit.

There was a manager registered with the Care Quality Commission (CQC). 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 previous inspection on 12 August 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; how risks associated to people’s needs were assessed and planned for, how the principles of the Mental Capacity Act 2005 was adhered to and good governance.

During this inspection we checked to see whether improvements had been made. We found improvements had been made in all the breaches identified at our last inspection. An action plan was in place to fully complete the action required that would ensure sustainability. However, new systems and processes were required to be more robust and further time was required for them to be fully embedded.

Risk assessments had been reviewed and updated to protect people from all potential risks. People felt the service was safe and the provider had arrangements in place to identify the possibility of abuse and to reduce the risk of people experiencing abuse.

Staff numbers were adequate and reflected the numbers of staff on the rotas to make sure people were supported appropriately. Staff had undertaken relevant safety checks and the provider had a robust recruitment process in place. Medicines were managed safely and appropriately.

People consented to the care and support they received, clear action was identified and the provider had taken action when a person lacked the capacity to make decisions for themselves. People could be assured that any restrictions would be identified and decisions would be made in their best interest.

Care plans contain information relevant to the person and they were person centred. People were encouraged to be independent and received relevant information on how the service was run. People felt that they could express their views about the service they received.

People were treated with compassion and respect. The staff provided the care in a caring way.

People were involved in decisions related to their care and support. Care plans contained information that reflected people’s needs, but it wasn’t always clear if the information was current and up to date.

People were comfortable to raise concerns. There was a complaints policy available and people told us their complaints had been responded to in a timely manner.

Systems in place to monitor the service were not fully accurate to make sure a quality service was provided at all times.

People were encouraged to express their views and comment on how the service was run.

The management team worked well together and supported staff accordingly. The service worked with other professionals and the care commissioners and recommendations were followed up in a timely manner.

One person told us they had no concerns about the building, the furnishings or the grounds and said, 'I got no complaints at all.'

We found there were effective recruitment and selection processes in place.

People using the service told us there were enough staff to provide the support they needed. One person said, 'They're all right. They look after you. They look after everybody.'

We found that supervision, appraisals and training were taking place. People using the service who we spoke with told us they felt staff provided good care and were well trained.

We found that people who use the service and staff were asked for their views about the service and they were acted on.

We found that a designated staff member had been employed to clean the building.

We looked at the downstairs bathroom and saw it was clean. We looked at most bedrooms and saw they were clean and hygienic.

We looked at the dining room and saw that the damaged flooring, table cloths and some chairs had been replaced and were clean.

We asked the registered manager about the systems in place for monitoring the cleanliness of the building. They told us that the cleaner recorded their activities in a daily routines book and the registered manager or another member of staff signed to state they had checked the standard of the cleaning. We looked at the book and saw records were being kept.

We spoke with four people using the service. We received mixed feedback about the care provided. One person told us their needs were met, 'A little bit' but said they did not always get the help they needed with their mental health.

Two other people told us they received good care and their needs were met. One of these people said, 'I'd say it was 100%'. The fourth person told us staff looked after them but told us they would like to go out more.

We saw there was no care plan in place that reflected that a person required insulin to control their diabetes.

We found several areas of the care home to be unclean and unhygienic. This placed people using the service, staff and visitors at significant risk of acquiring or spreading infections.

Three people using the service who we spoke with told us they were happy with their bedrooms and had everything they needed. They told us they felt the care home was well maintained. However, other evidence did not support this. We found that people were not protected against the risks of unsafe and unsuitable premises.

Two people using the service told us they felt there were enough staff to meet their needs and they did not have to wait long for assistance. However, the third person told us they did not feel there were enough staff to meet their needs. We found there were not enough staff to meet people's needs.

People told us their needs were met. One person said, 'They look after you.' They told us that staff arranged for them to see their GP and other professionals when needed. They also told us that staff communicated effectively with them. They told us they got enough to eat and drink.

People told us they felt safe and they would inform the manager or other staff if they were worried about anything. They told us staff were caring.

People told us they were happy with their bedroom and had everything they needed. They told us the home was well maintained and there was nothing they wanted improving. One person told us that the home was kept clean.

People told us staff were well trained and understood their needs. They told us they had a say in how the service was run and managed and that residents' meetings took place. One person told us that surveys had also been done. One person said the service was, 'Perfect, number one' and 'I've got no complaints.'

We observed staff speaking with people using the service and saw they treated people with dignity and respect.