Archived: Langdale Lodge

Langdale Lodge is a nursing home for up to 27 people. The home is situated in the town of Chesterfield, Derbyshire. At the time of our inspection 27 people were living there. The home provides care and support for people with a range of medical and age related conditions, including mobility issues, diabetes and dementia.

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.

People’s medicines were managed safely. There were procedures in place to ensure medicines were safely stored and administered.

The provider had thorough recruitment procedures in place and only employed new staff once appropriate checks had been completed. The provider had a system of ensuring new staff participated in an induction which included a period of shadowing an experienced member of staff. New staff undertook training in a range of topics, including safeguarding and health and safety, as part of their induction. There were enough staff deployed to support and respond to people’s needs in a timely manner. The registered manager and staff team understood their roles and responsibilities.

People’s care plans and records were complete and provided staff with the information they needed to meet people’s needs. People and their relatives were happy with the care and support provided and felt their individual needs were being met.

Staff and members of the management team maintained people’s safety and protected their rights. Training was provided and included the Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS) and safeguarding.

Staff knew people well and were aware of the importance of treating them with dignity and respect. Staff were kind, caring and compassionate; people’s self-esteem was promoted and staff supported and encouraged them to remain as independent as possible.

People’s nutritional needs were met and special dietary needs were catered for. People were supported to choose the food they wanted to eat. Staff understood people’s health needs and they were supported to access relevant health care professionals when this was required.

Information regarding how to make a complaint was available and complaints were dealt with swiftly. Audits were carried out to monitor the quality of care people in the home received.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the control of infection and cross contamination. The provider was not meeting these requirements due to the unclean condition of communal bathrooms and toilets and people were not protected from unsafe practices around the control of infection. Efficient cleaning regimes were not taking place in the communal toileting and bathing areas of the home.

A registered manager was not in post, as the previous registered manager had left the service. The operations manager informed us they were in the process of recruiting to the registered manager position. In the interim the operations manager was covering all the management responsibilities in the home and also held a CQC registration for another location. Following the inspection the operations manager applied to become registered with CQC to be registered manager at this location. 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.

Langdale Lodge has accommodation for 27 people; on the day of our inspection 24 people were living there.

People were protected from bullying and harassment by staff who could identify abuse and who knew what to do in a situation where they witnessed it. Peoples’ freedom was protected and there were sufficient numbers of staff on duty to meet their needs. Safe recruitment processes were in place to help to protect those living in the home.

Staff had the knowledge and skills they required to carry out their roles and responsibilities. They received the support they required with regard to induction, training and supervision sessions. Staff also felt comfortable to ask for any advice and guidance if they had any queries.

Medicines were managed in a safe way and people received medicines when they required them.

Staff received training related to the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) to make sure they knew how to protect people's rights.

People's nutritional needs were assessed and records kept to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified these were monitored and referrals made to relevant professionals.

Positive caring relationships had been developed between people and the staff who cared for them and people were supported to express their views. They were actively involved in making decisions about the care and treatment they received. People received care that responded to their wishes and needs and their views were respected and followed. People were supported to make choices about their lives. People were aware who to go to if they had any concerns or complaints and they were confident these would be acted upon.

Quality audits were undertaken to ensure quality of care was monitored, however the quality checks for cleanliness in the bathroom and toilet areas of the home had failed to identify the lack of cleanliness.

Was it safe?

Staff followed the Mental Capacity Act 2005 to make sure that people were asked for their consent before they received care. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People's care was planned and delivered in a way that was intended to ensure their safety and welfare and their health needs were properly accounted for. We saw that staff supported people safely and in a way that met their needs and mostly their preferences. One person's relative told us, 'He's much safer here; they (staff) know how to encourage him and how to approach him.'

Staff knew their responsibilities and those of others, for decision making about people's care and the providers written procedures informed and supported them in these. They included how to report any concerns about people's safety and welfare. People were protected against the risks of unsafe premises and there were procedures in place to ensure people's safety in the event of emergencies, such as a fire.

Was it effective?

People's needs were met by staff who said they received the training and mostly the support they needed. This helped to ensure that people would be cared for by suitably qualified, skilled and experienced staff.

People told us they received the care they needed. One person said, The care is good, the meals and good and the staff are great ' always helpful.' We found that the provider carried out regular unannounced monitoring visits, both during the day and at night, to check that people's care needs were being properly met.

People and their representatives were regularly asked for their views about the care provided. The provider's most recent periodic satisfaction survey results and minutes of meetings with people, showed their overall satisfaction with the care, staffing and daily living arrangements at Langdale Lodge.

Was it caring?

People experienced care that met their needs and mostly protected their rights. However, we noted with the provider that some people, who asked staff, were not provided with a hot drink at the end of their meal at lunchtime as they requested. They were provided with a choice of cold drinks during their meal.

We saw that staff supported people in a way that ensured their dignity and privacy. They encouraged people to be as independent as possible, with consideration to their individual conditions. They supported people at their own pace and were sensitive to the individual realities of people living with dementia or other mental health conditions.

Was it responsive?

We saw that some improvements had been made from matters raised by us and other health and social care professionals and authorities. These included people's care plans records and for their consent to their care.

The provider agreed people's care with them where possible and acted according to their wishes and best interests. We found where changes had been made from people's expressed views. These included food menus and activities.

Was it well led?

The provider had arrangements to regularly check the quality and safety of care people received at Langdale Lodge and also the environment and equipment there. Improvement plans were devised from these where required and progress was monitored by the provider to check that these were achieved and to ensure they were meeting with recognised national guidance. Recent action plans included for the prevention and control of infection.

Staff understood their role and responsibilities for meeting people's care needs and reporting any concerns or changes in people's health and safety needs. The provider held regular meetings with staff and provided them with key policy and procedural guidance to support them in their role. We found that management changes had contributed to a period of uncertainty and lowered morale for staff. However, staff felt that support from the provider and the recent appointment of a new manager had improved this. We also saw that further staff recruitment was in progress.

Staff said they were kept informed about people's care and usually received feedback about any changes or any learning from incidents or from the provider's checks of care and safety. Records, including minutes of recent staff meetings that we looked at reflected this.

People knew how to complain. One person told us, 'I don't need to complain. If there's a problem, I tell them; They (the staff) are brilliant, they listen and put things right if needed.'

We found that where people could make decisions for themselves they were involved in decision making regarding their care. However where people lacked capacity there were not suitable arrangements in place to demonstrate that appropriate procedures were used to assess and record how decisions were being made on people's behalf.

People were routinely offered a choice of food and drinks. The people we spoke with told us that the food was of a good quality. Where there were concerns regarding people's weight dietary intake was monitored and referrals made where necessary to dieticians and speech and language therapists.

We found the home to be visibly clean and there were systems in place to manage and reduce the risk of infection.

Staff received regular training in order that there were suitably skilled to meet people's needs. Training was mostly up to date with just a few gaps evident. Staff told us that where there were gaps training was being arranged. Systems were in place to provide suitable induction and on-going supervision to staff.

Records at Langdale Lodge were kept up to date and secured securely. This ensured people's confidentiality was protected.

People told us that the staff treated them with respect.

The level of detail in care plans demonstrated that people had been asked about routines and preferences although not all records had been signed by the person or their relative to confirm this.

People told us they were satisfied with the cleanliness of the service, however, we observed some areas that were untidy and where we saw practices did not limit the risk of infection.

There were suitable arrangements in place for the handling and administering of medicines. Staff were suitably trained and had access to information about medicines. We spoke with two people who told us that staff always gave them medicines at regular times.

There were robust recruitment procedures in place. This ensured that staff were suited to work with vulnerable adults.