Archived: Langlea House Care Home

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

People felt safe. One person said, “Yes, I feel safe because I know I’m not on my own.”

Systems were in place to safeguard people from the risk of abuse. People received their medication as prescribed by staff who had been appropriately trained. Risks to people were effectively managed through person centred risk assessments and care planning.

We have recommended the provider reviews the whistleblowing procedure to include details of agencies external to the service for whistleblowing purposes.

Safe infection prevention and control (IPC) practices were in place to minimise the risk of spread of infection.

Systems in place to monitor the service were effective in identifying and addressing areas that required improvement. There was a positive culture at the service. People were happy with the support they received. People’s opinions about the service were sought and people were kept up to date about any changes.

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 requires improvement (published 1 February 2020).

Why we inspected

This inspection was prompted through our intelligence monitoring system. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

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 remains as requires improvement.

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

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.

Langlea House is a residential care home providing accommodation and personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 14 people.

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

Medicines were not always managed safely. Although we did not see people had come to any harm, there was a risk of harm if the provider did not follow medication policies and procedures. We concluded there was a breach of regulation 12 (safe care and treatment).

The provider had begun to put quality assurance systems in place. However, we found there was no effective overview of safeguarding incidents. Since people's care records had been updated, care plan audits had not commenced. We found instances where there was contradictory information in a person’s care record and one person’s care plan had not been updated following an incident.

The home was clean and appropriately maintained. To ensure risks were not overlooked, we made a recommendation that the provider set a minimum frequency for when the fire drill occurred.

People and their relatives were complimentary about the staff. One person told us, “Very friendly staff. I can't fault them because it's such a small place, it's got a family feel.” Another person said, “No concerns about the care, I'm always really pleased, it's like a big family.” The registered manager had created links with the local community, such as inviting children from the local nursery into the home.

Staff were recruited safely. To ensure risks were not overlooked, we made a recommendation that the provider included a section regarding gaps in employment, to ensure these were explored. Staff received appropriate training and felt supported. Although the provider had begun to take steps to follow the Assessible Information Standard, we found this had not yet been met. People with a disability, impairment or sensory loss, were not always given information in a way they could understand.

Overall 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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 October 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in regulation 19 (fit and proper persons employed) and the provider was no longer in breach of regulation. However, although we found some improvements had been made in relation to regulation 17 (good governance), the provider remained in breach of this relation.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider told us they would take action to mitigate the risks found.

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

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.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Langlea House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides nursing and personal care for up to 14 older people, some of whom may be living with dementia. Accommodation is provided on two floors with chair lift access between floors. There are communal areas on the ground floor, including a lounge, conservatory, dining room and visitors room. There were 10 people in the home when we inspected including one person who was in hospital.

The home has 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 our last inspection on 14 March 2016 we rated the service as ‘Good’ and there were no regulatory breaches. At this inspection, we have rated the service as ‘Requires Improvement’. Although we found some aspects of the service were good, we found others required improvement. This was in relation to recruitment processes, record keeping and quality assurance systems. We identified two breaches of regulation; Regulation 19 (Fit and Proper Persons Employed) and Regulation 17 (Good Governance).

Staff recruitment procedures were not robust as thorough checks had not always been completed before staff started working in the service. Staff received the induction, training and support they required to carry out their roles.

Staff had received training in safeguarding and understood the reporting systems. Safeguarding incidents were reported to the local authority safeguarding team. Staff were aware of how to manage risks to people, however this was not always fully reflected in risk assessments which required more detail.

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.

There were sufficient staff to meet people’s needs. People and relatives were happy with the service provided. They said staff were kind and caring and respected people’s privacy and dignity. People’s nutritional needs were met and people had access to healthcare services.

Activities were provided and opportunities to go out which people told us they enjoyed. Systems were in place to manage any complaints.

People received personalised care and staff were kept informed of any changes in people’s needs through handover at each shift change. However, people’s care records were not always up to date or accurate and there was not enough detail to guide staff about the care and support people required. Medicine management was safe, although some improvements were needed in relation to record keeping.

People, relatives and staff praised the management of the home. The registered manager had already identified improvements were needed and an action plan was in place. New care documentation had been developed and was due to be in place by December 2018. The quality audit systems and processes needed to improve to enable the provider to effectively assess, monitor and improve the service.

You can see what action we told the provider to take at the back of the full version of the report.

Langlea House provides accommodation and personal care for up to 14 older people, some of who are living with dementia. There were nine people living at the home when we visited.

The accommodation consists of ten single bedrooms and two shared rooms, all of which have ensuite facilities. On the ground floor there is a lounge, conservatory, dining room, kitchen, laundry and a visitors/hairdressing room. There is a car park at the front and gardens to the rear of the property.

The home has a registered manager who has been in post since 2010. 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 told us they felt safe and we found risks were well managed. There were enough staff to meet people’s needs. Staffing levels were kept under review and increased accordingly if there were new admissions or people’s dependencies increased. Staff recruitment processes ensured staff were suitable and safe to work in the care home.

Staff had a good understanding of safeguarding and knew the reporting systems if any allegations of abuse were raised.

Medicines were managed safely and systems which ensured people received their medicines when they needed them.

Staff knew people well and supported people in accordance with their individual preferences and needs. Staff received the training and support they needed to carry out their roles.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

The home was clean and well maintained. People told us they enjoyed the food and we saw a wide range of food and drinks were available. People’s weights were monitored to ensure they were getting enough to eat and drink. People had access to healthcare services such as GPs and district nurses.

People were comfortable and relaxed around staff. We saw staff treated people with respect and maintained their privacy and dignity. Staff were kind, caring and considerate and care was centred around people’s needs and preferences. People looked clean, well dressed and well groomed.

Relatives spoke highly of the care provided and praised the providers, registered manager and staff team. People’s views were listened to and acted upon. For example, new communal toilets with more space had been provided on the ground floor.

A range of activities were provided including Wii games, arts and crafts and going out for walks. Daily newspapers were available. We saw staff spent time sitting chatting with people and nothing was rushed as staff gave people time to do things at their own pace.

Langlea House is a family-run home and we saw the registered providers took an active role in the day to day running of the service and worked alongside the registered manager and staff team to ensure people received a quality service. The registered providers and registered manager led by example and provided support to the staff team. People, relatives and healthcare professionals gave positive feedback about the home and the care provided to people.

We went back on this inspection to check whether improvements had been made.

We looked at the care records of three people who lived at the home and found they all contained documentation to show each person had given their consent to the care and treatment they received at the home.

We looked at evidence which showed the manager had systems in place to regularly assess and monitor the quality of service people received.

We saw staff records, care records and other records relevant to the management of the services were accurate and fit for purpose.