Archived: Langdale Residential Home

Langdale Residential Home provides both care and nursing for up to 31 people who are aged over 65 and who are living with Dementia or who have a physical disability. The home is located on two floors. Each person had their own bedroom. The home had a communal lounge, kitchen and dining room where people could spend time together. At the time of inspection there were 31 people using the service.

The service 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.

People and staff felt the service was well managed. The service was led by a registered manager who understood most of their responsibilities under the Care Quality Commission (Registration) Regulations 2009. We found that not all statutory notifications had been submitted to the Care Quality Commission.

People were protected from the risk of harm at the service because staff had undertaken training to recognise and respond to safeguarding concerns. They had a good understanding about what safeguarding meant and how to report any concerns.

There were effective systems in place to manage risks associated with people's care and this helped staff to know how to support people safely. Where people displayed behaviour that may cause harm to themselves or others guidance was available to staff to help them to manage such situations in a consistent and positive way.

The building was well maintained and kept in a safe condition. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. People’s GPs and other healthcare professionals were contacted for advice whenever necessary. People had access to healthcare service when required.

There were enough staff to meet people’s needs. People felt that they had to wait for support at times. Staff had been checked for their suitability before starting work to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through induction and supervision. There was an on-going training programme to provide and update staff on safe ways of working.

People were supported to maintain a balanced diet and guidance from health professionals in relation to eating and drinking was followed. We saw that people were able to choose their meals.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We found that DoLS applications and appropriate assessments of capacity had been made. Staff told us that they sought people’s consent before delivering their support.

People or their representatives had contributed to the planning and review of their support.

People received support from staff who showed kindness and compassion. They told us that staff treated them with respect.

People received care and support that was responsive to their needs and preferences. Care plans provided detailed information about people so staff knew what people liked and what they enjoyed. People were encouraged to maintain and develop their independence. They took part in some activities that they enjoyed although people felt that the activities were limited. People were involved in developing their support plans.

Systems were in place which assessed and monitored the quality of the service. This included obtaining feedback from people who used the service and their relatives although people did not remember being asked for this.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people who used the service, a relatives of another person, four staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw several examples of how staff treated people with dignity and respect and as individuals. Staff engaged in meaningful and stimulating conversation people. Staff spoke politely to people and offered encouragement when they supported. We saw staff used lifting equipment safely when they transferred people from their chairs to wheelchairs. Relatives we spoke with told us that they felt their family members were safe at the home. A relative told us, "My [family relative] is safe here. The staff are fabulous and patient. I've no concerns."

Care plans we looked at contained risk assessments of things that could potentially harm people. Care plans included plans of how to protect people from risk of falls and risk of injury whilst receiving personal care.

Relatives and staff told us that they felt enough staff were always on duty. A relative also felt that enough staff were on duty. We found that people who used the service were safe because enough staff were on duty.

Staff knew how to report accidents and injuries. Procedures were in place for managers and staff to learn from events such as accidents and incidents. That meant the service placed a high priority on people's safety.

Senior staff we spoke with had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. On the day of our inspection most of the care workers employed by the provider attended training about the MCA and DoLS. The training was provided by a NHS Trust.

We were shown around the home. We saw that people's bedrooms and communal areas were clean, tidy and free from odours. A person who used the service told us, "It's ever so clean here."

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how people were supported with their needs. Care plans and records we looked at that showed that people had received the support they required.

A person who used the service told us, "It's very friendly here. We are all well looked after here. If we ask for anything they always try to help." Another person told us, "I'm happy here." A relative of another person who used the service was complimentary about the service. They told us, "The quality of care is very good. I've seen my [relative's] care plan. It's good and includes details of care routines. I'm confident that staff complete the routines." When we looked at care plans and associated care records we found that they provided assurance that people's care needs had been met.

All the people who used the service were registered with a local GP surgery. The provider had arranged weekly GP visits so that people's health could be checked.

Relatives were able to visit the home at times they wanted. We saw relatives visit throughout our inspection.

We found from the evidence we gathered that the service had effectively planned and delivered care that met people's needs.

Is the service caring?

People told us they were "happy" and "well looked after". One person told us, "The carers are very good. They are nice and caring. It's nice here." Another person told us, "It's friendly here." A relative told us, "The service has kept be involved and aware. The staff are fabulous and patient. They have a good rapport with [my relative]." We looked at a folder of compliments cards and found two recent cards. Relatives wrote, "Staff showed nothing but care and compassion"; and in another card, "A lot of the worry for [relative's] wellbeing was taken from my shoulders." We found that staff were attentive to people's needs and showed kindness and patience.

Staff used people's preferred names when they spoke with them and treated people with dignity and respect.

Some of the people who used the service spent most of their time in their bedrooms. We found that staff were attentive to those people's needs. Staff carried out frequent and regular observations of those people to check that they were comfortable.

People had been supported with their health and nursing needs because the service worked closely with providers of those services. We found that staff monitored people's health and made referrals to the appropriate specialists when required.

People's preferences, interests and diverse needs had been respected. People had been able to attend church services or receive visits from representatives of local churches. People took part in social activities that involved other people and had also been supported to enjoy activities that were of particular interest to them. An activities coordinator had ensured that people had been offered meaningful and stimulating activities each day.

We found that the staff understood people's individual needs and had supported people with those needs in a caring way.

Is the service responsive?

People told us they were well looked after. Records we looked at showed that people had been supported with their personal care, nursing and health needs. Relatives told us that they knew how they could make suggestions or raise concerns and that they were confident they would be listened to. A relative told us, "I'm able to give my feedback and views. I've never had to raise concern but if I had any I know how to and I'm confident I'd be listened to."

We saw that the service had responded to changes in people's needs. People's care plans had been updated to show how their needs had changed. We saw that people's care and support routines had been modified or added to in order to support people with new or short term requirements. It was evident that staff regularly read people's care plans and had provided care and support that met people's new and changing needs.

All relatives we spoke with told us that the service had kept them informed about their family member's welfare.

We found that the service had been responsive to people's on-going and new needs.

Is the service well-led?

The service had a system for monitoring the quality of service. This included checks of documentation and records and observations of care worker's practice. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again.

The manager regularly sought the views of people who used the service and their relatives. That had been through one to one discussions with people and reviews of people's care plans. The provider also used a satisfaction survey to obtain people's views.

The service worked closely with doctors, district nurses and other health professionals to ensure that people's health and well- being had been provided for. The registered manager and deputy managers were qualified nurses. This showed that the service was well led

We found people's privacy, dignity and independence was compromised at times. We saw two occasions where one member of staff was assisting two people with their meal at the same time. We saw two people being assisted with their mobility in a hoist without their dignity being maintained.

We found people experienced care and support that met their needs and protected their rights. We found people's care needs had been assessed. Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

People using the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. There were areas, such as the lounge, which were cluttered and used as a storage area. We had concerns about the passenger lift which is planned to be replaced in March 2014.

We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We spoke with nine people using the service and five relatives. We also spoke with eight members of staff and five visiting social and health care professionals.

We found people's privacy, dignity and independence were respected. One person told us 'staff bend over backwards to help us.' Another person told us 'staff are always respectful.'

We found people experienced care and support that met their needs and protected their rights. One relative told us their family member 'always looks well looked after." We found people's care needs had been assessed. Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

People were protected from the risk of abuse and staff knew how to raise any concerns. We found the provider had policies in place relating to the safeguarding of vulnerable adults and whistle blowing.

We found there were effective systems in place to reduce the risk and spread of infection.

We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

The environment as friendly and welcoming, we saw that the provider regularly reassessed people's needs and adjusted their care whenever necessary to provide the most appropriate support to meet a person's changing needs.