Archived: Langley House

The home is registered for eight people with mental health needs, but actually provides support for three people who are independent and require only minor prompting or reminding with personal care and medication.

This home is not required to have a registered manager as part of its conditions of registration. The provider is the registered person and they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

At the last inspection on 5 October 2016 we carried out an unannounced comprehensive inspection and found the provider was not meeting the regulation with regard to medication under the ‘safe’ question. The provider told us they would address the concern immediately.

We undertook this focused inspection on the 16 March 2017 to check that they now met legal requirements. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Langley House on our website at www.cqc.org.uk.

We found the provider had reviewed the management of medicines to ensure it supported people safely. There was a process in place for ordering, checking, receiving and storing medicines. Risk had been assessed to enable people to be responsible for their own medicines and records were kept to ensure they had taken them.

Langley House was a family environment with the provider living in the home with the three people they supported, although in a separate part of the building. The provider had been responsible for the home for over 25 years and their family had grown up within the care environment and were now working as staff. There had been no new staff employed at the home for several years and the provider had no plans to change the current staffing level.

People said they had the support they wanted. One person told us they were very happy living in the home and had been involved in decisions about the services provided. They said, “I have lived here for 21 years and am very happy. I will be going out later after dinner.”

Risk assessments had been completed to ensure people were supported safely to be independent and people said they felt safe and received the support they needed. Staff had attended safeguarding training. They demonstrated a good understanding of their responsibilities with regard to supporting people and the action they should take if they had any concerns.

A considerable amount of refurbishment had taken place. New lighting had been installed in the communal areas; improvements had been made to the kitchen people used and a separate dining room would be available to them when the work was completed.

This inspection was announced carried out on 5 October 2016. The reason we gave short notice was because this is a small home and we wanted to be able to speak with people and have access to records. At the last inspection on January 2014, we found the provider was meeting the regulations we looked at.

At the time of the inspection there were three people using the service. The service aims to support people to live as independently as possible. No one living at the service currently requires support with personal care. We discussed whether the service needed to be registered with CQC.

A registered manager was in place and lives on site. 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 managed their own medicines, but staff did not record or keep records of people’s compliance to take their prescribed medicines or the amount being received into the home. This may have placed people at risk, although we have judged the impact to be minor as people would be able to say if their medicines did not have the correct amount in the blister packs.

People benefited from a clean home with no unpleasant odours. However, the service was using cloth towels in communal bathrooms which could mean a risk that cross infection was not fully controlled. When we fed this back, they agreed they would install paper towels to reduce the possible risk of cross infection

Risk assessments were basic and did not always include details of what staff should do if for example someone did not return at the stated time they said they would return. Again the registered manager agreed to address this promptly.

People received effective care from a small team of staff, who were familiar with people’s needs and preferences. People were very happy at the service and described it as “home”. One person said ‘‘I have lived here a long time, I do not want to live anywhere else. This is my home” People enjoyed positive and respectful relationships with staff. Staff treated people with dignity and kindness. People spoke highly of the staff, one saying, “We all get on, the staff are very nice.”

People's care plans detailed how they wanted their needs to be met. They helped to promote people's independence whilst minimising the risks. People managed their own medicines but the service still had a responsibility to ensure this was monitored and that records were kept of medicines being delivered to the service.

People's health and wellbeing were maintained and they received specialist input from a range of health professionals when needed. People's nutritional needs were met and there was a collaborative approach to meal planning and preparation.

Staff received the training and development they needed to care for and support people's individual needs. The registered manager provided daily advice and support but there were no records of regular supervision or staff meetings. They said they were a very small team and spoke daily about how people were, and about the running of the service, so did not need to have formal meetings.

People were protected because safe recruitment processes ensured only staff who were suitable to work with vulnerable people were employed.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people's rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues, which related to the people in their care. Everyone had capacity to make their own decisions in their daily lives and where support may be needed to make decisions, staff and family members were on hand to provide this advice. The staff team understood the principles of best interest decisions and upholding people’s rights.

An open culture had been developed and people were encouraged to contribute to the running of the service. The registered manager and staff team sought people's views on a daily basis, on the service in order to develop and improve. For example discussing menu choices and how they wished to have their rooms decorated.

Simple but effective auditing systems were in place to monitor the quality and safety of the service such as regular fire checks, monitoring of water temperatures and regular reviews of care plans . There were arrangements in place to monitor accidents and incidents.

We found one breach 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.

There was evidence in place that showed us that people were supported to give valid consent to the care and treatment they received.

People had their individual needs and wishes recorded in a plan of care that was regularly reviewed and updated.

There were processes in place to protect people from risk of abuse or harm. Staff that spoke with us had received relevant training and were aware of their responsibilities.

The environment was warm, homely and comfortable. There was a programme of works to improve the environment being carried out.

Robust recruitment and selection processes were in place and staff received training relevant to their role.

A family member that spoke with us said. 'My son always seems very happy and relaxed in the home, they keep me in touch and I can visit at any time.'

People told us there were supported to be independent in all aspects of daily living. They told us they could choose how they spent their day, where they went and what they had to eat. We were told that staff "were nice," and they felt supported by the care workers at the home. One person told us, 'If there is something on my mind I can tell the staff.' People were very complimentary about the variety of food they were offered and the flexibility about eating what and when they wanted.

We found that the staff that we spoke with had worked in the home for a long time. They were aware of the needs of the people who used the service and how to support them effectively. One care worker told us, 'People are happy here.' Another said, 'I like working here. It's enjoyable. It's rewarding to help people become independent.'

We looked at systems and processes the home had in place to ensure that standards of quality were reviewed and maintained.

There were a number of refurbishments taking place at the home at the time of the inspection.