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Langley Court Rest Home Good

Reports


Inspection carried out on 29 August 2017

During a routine inspection

Langley Court Rest Home provides care for up to 28 older people, some of whom may be living with dementia. There were 26 people using the service at the time of this inspection.

The home had 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.

People felt safe living at Langley Court and spoke positively about the care provided to them. Staff knew people well and treated people with kindness, dignity and respect. Relatives and friends were welcomed and people were supported to maintain relationships with those who matter to them. People spoke about the friendly and homely atmosphere and this was evident on both days we visited.

There were enough staff to meet people’s needs and a consistent team of staff provided continuity of care to the people staying at Langley Court. A new electronic care planning system had been introduced to make sure people’s care and support needs were fully assessed, documented and reviewed at regular intervals.

People were supported to have their health needs met. We saw that people’s prescribed medicines were being stored securely and managed safely.

Staff had good access to training that gave them the knowledge and skills to support people effectively. Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by senior staff and acted upon.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of giving choice and gaining people’s consent before assisting them.

There was a system in place for dealing with people’s concerns and complaints. The registered manager understood their role and responsibilities and positive feedback was received from people and staff about the senior staff team working at Langley Court.

There were systems in place to help ensure the safety and quality of the service provided.

Inspection carried out on 5 May 2017

During an inspection looking at part of the service

This inspection took place on 5 May 2017 and was unannounced.

At our last inspection on 18 and 19 August 2016 we found a breach of the regulation in relation to person centred care. Care plans did not always take into account people's long-term care needs and did not always take into account the ways in which people's needs changed over time. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to person centred care. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements and to one area in respect of quality assurance that required improvement. The provider sent us an action plan and told us they had already made the necessary improvements by 3 October 2016. We undertook this inspection to check they had followed their plan, to confirm that they now met legal requirements.

Langley Court Rest Home provides residential care for up to 28 people. At the time of our inspection there were 23 people using the service and 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 this inspection we found that the provider had introduced a new care planning system, which was designed to draw attention to any missing or out of date information. Care plans now contained detailed information about people’s care needs, health conditions and preferences about their care. People were involved in planning their care and in regular reviews that took place to ensure that care plans were up to date with people’s changing needs and preferences.

The provider consulted appropriate guidance on care planning and had also introduced systems to help ensure new information relating to people’s care needs was communicated efficiently between staff and added promptly to care plans.

We found the provider had made the necessary improvements to rectify the breach of regulations we found at our last inspection and had also improved their quality assurance systems and we are changing the ratings for the relevant key questions as a result. However, according to our guidance, where a focused inspection takes place more than six months after the last comprehensive inspection, we are not able to change the service’s overall rating. This is because we need to review all of the key questions in order to do so. We will review the service’s overall rating at our next comprehensive inspection.

Inspection carried out on 18 August 2016

During a routine inspection

This inspection took place on 18 and 19 August 2016 and was unannounced. At our last inspection on 21 January 2016, we found breaches of the regulations in relation to governance and staffing. We imposed two requirement notices. At this inspection we checked to see if the provider had taken action to address these.

Langley Court Rest Home is a residential care service for up to 28 people, including those living with dementia. At the time of our visit there were 22 people using the service. 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 this inspection we found the provider had taken the necessary action to make sure staff received regular supervision to support them in carrying out their roles. All care staff had received supervision in the last three months and training was up to date. Staff had opportunities to study for relevant qualifications to broaden their knowledge about social care work.

Care plans did not always take into account people’s long-term care needs such as mental health conditions and incontinence. We also found that care plan updates did not always take into account the ways in which people’s needs changed over time. We found a breach of the regulation in relation to person-centred care. You can see what action we have asked the provider to take at the back of this report.

The provider had a range of audits in place to check the quality and safety of the service. These included audits of safety, medicines and care plans. However, the care plan audit had not identified that some information about people’s long-term or changing needs was missing from care plans.

We found the provider was not displaying their CQC rating, which is a legal requirement. However, when we informed managers of this they made sure it was done promptly.

People told us they felt safe. The home had appropriate procedures in place to protect people from abuse and report suspected abuse. Staff were familiar with these. People had risk assessments and management plans in place to identify and mitigate risks to their safety, whilst helping them retain their independence as much as possible. There were enough staff to care for people safely and the provider carried out appropriate checks during the recruitment process to help ensure staff were suitable.

The provider regularly checked the premises, equipment, moving and handling techniques used by staff and fire safety precautions to make sure these were safe and effective. There were procedures in place to manage emergency situations. The provider also had appropriate arrangements in place for the safe storage of medicines. Stock balance records and medicines administration records indicated that people received their medicines when needed.

Staff obtained people’s consent before carrying out care tasks. Care plans contained information to help staff do all that was reasonably possible to help people understand the information they needed to consent to their care. If people did not have the capacity to consent, the provider followed the processes that are legally required by the Mental Capacity Act (2005) to ensure that decisions made about people’s care, including any restrictions on their freedom, were made in their best interests and did not compromise their rights.

People received a variety of food and drink that met their needs and preferences. Where people did not want the dishes that were offered, the kitchen staff met their requests for alternative choices. Staff monitored people who were at risk of malnutrition to make sure they ate enough to stay healthy. People had access to the healthcare support they needed, including referrals to other serv

Inspection carried out on 21 January 2016

During a routine inspection

This inspection took place on 21 January 2016 and was unannounced. At the last inspection on 4 August 2015 we found the service was breaching the regulation relating to safe care and treatment due to issues we found regarding medicines management.

Langley Court Rest Home provides accommodation and personal care for up to 28 older people, many of whom live with the experience of dementia. On the day of our visit there were 24 people living in the home.

The home had a registered manager. 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 this inspection we found the provider had taken the necessary action to improve medicines management and risks to people from unsafe medicines practices were much reduced. Medicines were stored, administered, recorded and disposed of safely.

Staff were not always provided with the necessary supervision and appraisal to carry out their roles. However, staff were provided with a suitable level of induction and ongoing training to understand how to support people using the service appropriately. We found a breach of the regulation in relation to how the provider supported staff. You can see what action we have asked the provider to take at the back of this report.

A range of audits was in place for the provider to assess, monitor and improve the service. However, these audits had not identified deficiencies in the way risks relating to hot water temperatures and falling from height were managed, as well as in staff support, supervision and appraisal. The registered manager told us they would review their quality assurance processes in light of our feedback. This was a breach of the regulation in relation to good governance. You can see what action we have asked the provider to take at the back of this report.

The provider made applications to deprive people of their liberty lawfully and notified CQC of the applications and outcomes as required by law. However, staff did not all have a good understanding of their responsibilities under the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards. The provider was aware of this and had planned further training in these topics for staff to improve their understanding.

The provider monitored people’s risk of malnutrition through closely monitoring their eating and drinking patterns. However, the provider did not always monitor people’s weights accurately which meant their systems of identifying people who were at risk of malnutrition were not as robust as they could be. People received appropriate support with their health needs, such as accessing the healthcare professionals they needed to support them.

Generally the provider managed risks to individuals well through their risk assessment and management processes. However, risks to people from hot water temperatures and falling from height were not always managed well because the water temperature at hot water outlets was above 50 degrees centigrade and some windows did not have effective restrictors in place. The provider took prompt action to address these concerns when we informed them of our concerns. Besides these issues other aspects of the premises and equipment were managed safely with suitable checks in place.

The provider and staff understood their responsibilities to safeguard people from abuse. The provider had referred allegations to the local authority safeguarding team for investigation and had notified CQC as required by law.

There were enough staff deployed to care and support people appropriately in the service. The provider recruited staff through robust procedures to check they were suitable to work with people using the service.

Staff were kind and compassionate and treated peopl

Inspection carried out on 04/08/2015

During an inspection looking at part of the service

This inspection took place on 4 August 2015 and was unannounced. At the last inspection on 20 April 2015 we found the provider was continuing to breach the regulation in relation to medicines management and we served a warning notice in relation to this.

We carried out this focused inspection to check whether the provider had complied with the warning notice. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Langley Court Rest Home on our website at www.cqc.org.uk.

Langley Court Rest Home provides accommodation and personal care for up to 28 older people, many of whom live with dementia. On the day of our visit there were 19 people living in the home.

The home had a registered manager. 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 this inspection we found the provider had made the necessary improvements to meet the requirements of the warning notice. However, we identified some areas where best practice in relation to medicines management was not being followed in relation to medicines storage and having guidance in place for staff to follow in relation to topical medicines such as creams, ointments and medicines which were prescribed as required. You can see the action we told the provider to take at the back of the full version of this report.

Although auditing systems in relation to medicines management had improved, they had not identified the issues we found.

Inspection carried out on 20/04/2015

During an inspection looking at part of the service

This inspection took place on 20 April 2015 and was unannounced. At the last inspection on 17 October 2014 we found the provider to be breaching regulations in relation to care and welfare, medicines management and assessing and monitoring the quality of the service provision. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Langley Court Rest Home on our website at www.cqc.org.uk.

Langley Court Rest Home provides accommodation and personal care for up to 28 older people, many of whom live with dementia. On the day of our visit there were 24 people living in the home.

The home had a registered manager. 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 this inspection we found the service had not taken sufficient action to improve medicines management to keep people safe. When we checked medicines stocks we could not always confirm people received their medicines as records showed. In addition, staff who administered medicine were not always able to focus on carrying out this task. During our inspection this meant medicines were administered late and this could also be a cause of medicines errors. Although we found required improvements in relation to medicines storage had been made we found the service was in breach of the regulation in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

Required improvements had been made to risk assessment and care planning in relation to pressure ulcer management and choking. Risk assessments to identify risks to people and care plans to guide staff as to how to provide care to people safely were in place and regularly reviewed.

We found the safety of the premises had improved. This was because alarms had been installed on fire doors. This meant that should people who required staff support to remain safe outside the home leave the premises alone staff were alerted and could provide support.

Systems to audit the quality of the service had improved in relation to checking care. However, systems to check the safety of medicines management remained ineffective in identifying concerns.

Inspection carried out on 17/10/14

During a routine inspection

This inspection took place on 17 October 2014 and was unannounced. At the last inspection on 9 October 2013 we found the service to be meeting the regulations we looked at.

Langley Court Rest Home provides accommodation and personal care for up to 28 older people, many of whom live with dementia. On the day of our visit there were 20 people living in the home.

The home had a registered manager. 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.

Care plans and risk assessments were not always in place with regards to risks, such as risk of choking and pressure ulcer prevention and management.

Medicines, including controlled drugs were not always stored or administered safely.

Risks relating to the premises were generally well managed. However, people who required supervision when in the community were at risk of coming to harm as they were able to leave via a fire door without staff being aware.

The service had responded appropriately to allegations of abuse and staff had a good understanding of how to recognise abuse and how to help protect people from the risk of abuse or harm.

There were enough staff employed to meet people’s needs. Recruitment procedures ensured that only people who were deemed suitable worked within the home. Staff were provided with support and training to help them to carry out their roles. Staff had effective induction, support and training.

Accidents and incidents were reviewed to identify patterns and prevent these from happening again.

Staff had a good understanding of the Mental Capacity Act 2005 and their responsibilities under this, with clear policies in place. We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. People’s rights in relation to this were therefore properly recognised, respected and promoted.

People were provided with a choice of food and were supported to eat when required. The service supported people who were at risk of malnutrition and those with specialist needs related to their diet. People were supported effectively with their health needs and in accessing health professionals.

Staff had a good knowledge and understanding of people’s individual needs and preferences.

They treated people with kindness and compassion, dignity and respect and people were involved in decisions about their care.

A range of activities was offered to people using the service. People were supported to meet their religious and cultural needs.

People using the service, relatives and staff were encouraged to give feedback on the service and raise issues of concern. People knew how to make complaints and there was an effective complaints management system in place.

CQC registration requirements, including the submission of notifications in relation to safeguarding and applications to deprive people of their liberty and their outcomes had been met.

At this inspection, there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to care and welfare of people and medicines management. Although there were some quality control systems in place, the provider had not identified these issues. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 9 October 2013

During an inspection looking at part of the service

People we spoke with were complimentary about the way they were treated at the home. One person told us: "I am quite happy here and have no complaints". Another person told us that they found the staff very caring.

People had been asked how they preferred their personal care to be given and that this had been recorded in their care plans. Support with personal care included having staff of the same gender to assist people wherever possible.

We found that care plans and assessments had been carried out with the involvement of the individual, staff and family members where appropriate. Daily records were up to date.

We saw that improvements had been made to the office area of the home, with new filing cabinets in place and previous clutter gone. We saw records had been updated and cleansed of old and duplicate material and safely stored in filing cabinets.

Inspection carried out on 16 July 2013

During a routine inspection

People we spoke with were complimentary about the way they were consulted and spoken to regarding their care. One person told us "They are lovely here". We saw care staff engaging with people in friendly and respectful terms and when personal assistance was required this was provided in a careful and unhurried manner.

We saw that food was prepared by the in-house cook and was presented individually to people. The food was appropriately hot, had an appropriate mix of vegetables and carbohydrates and was provided in sufficient quantities. We saw that care staff ensured that water jugs and glasses were placed in such a way that people could reach them easily.

We found that there were procedures in place to ensure visitors to the home used a disinfectant gel before meeting people. There were policies and procedures in place regarding infection control and staff were seen to wear appropriate clothing during their work. Staff we spoke to were enthusiastic about their role and demonstrated a sound awareness of the needs of individuals. They also confirmed that they had undergone induction programmes when they started work and were supported to develop their training and personal development.

We saw that there was a regular system of asking people and their relatives for feedback about the service and that the manager had daily contact with people and visitors. we also saw that the provider had regular contact with the home and the people who lived and worked there.

Inspection carried out on 4 January 2013

During a routine inspection

We found that people we spoke with were complimentary about the way they were consulted and spoken to regarding their care. People who use the service were given appropriate information and support regarding their care or treatment.

We looked at a sample of records and care plans. These showed that people�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We observed that people were supported to be able to eat and drink sufficient amounts to meet their needs and received appropriate assistance where required. People had the choice of eating in the main dining area, at a table in the lounge or in their own rooms.

The home had a procedure in place for the reporting of any concerns regarding safeguarding.

We found that people were protected from the risk of infection because appropriate guidance had been followed and they were cared for in a clean, hygienic environment.

Staff we spoke with confirmed that they had been checked and interviewed prior to employment in the home. One new member of staff confirmed that they were about to go on an induction course, while other staff told us that they had received updated training in areas such as safeguarding, moving and handling and medication administration.

The provider had an effective system to regularly assess and monitor the quality of service that people receive, which included seeking the views of relatives and staff.

Reports under our old system of regulation (including those from before CQC was created)