28 May 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Two inspectors and an Expert by Experience conducted the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Langdale Nursing Home 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced.
We gave a short period notice of the inspection to the home prior to our site visit to enquire about the current Covid status in the home.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.
During the inspection
We spoke with six people who used the service and nine relatives about their experience of the care provided. We spoke with eight members of staff including the provider, registered manager, senior care workers, care workers and the cleaning supervisor. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at eight staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
28 May 2021
About the service
Langdale Nursing Home provides accommodation, nursing and personal care for up to 39 older people, some of whom live with physical disabilities. Accommodation is arranged over two floors with stair lift and passenger lift access to all areas. At the time of our inspection 36 people lived at the home.
People’s experience of using this service and what we found
Medication was dispensed and administered in a safe manner. We saw staff administered medicines to one person at a time, to minimise any risks associated with this process. Staff had received formal training to ensure they were confident and competent to give people their medicines.
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.
Family members told us the home provided a safe environment for people and described how the service had clear COVID protocols. These minimised the risk of infection and yet allowed visiting within a custom-built chalet, a summer house in the garden, and inside in a dedicated COVID secure room. Even prior to COVID, relatives said that environmentally the home was safe, and that people were treated very well by staff and other people living in the service?
People were kept safe from avoidable harm and abuse. The provider had safeguarding procedures in place, which staff understood and followed. Risk assessments reflected how care should be provided to minimise any risks to people; they were regularly reviewed to adapt the level of support needed in response to people's changing needs.
People and their relatives told us they were happy with the variety and choice of meals available to them. Regular snacks and drinks were available between meals, to ensure they received adequate nutrition and hydration.
People received care and support that met their needs. People's care and support needs were assessed, and good practice guidance was followed. People were involved in the planning and review of their care and were encouraged to express their views, preferences and wishes regarding their care, support and treatment. This included any end of life wishes they had.
A professional told us they were always welcomed and attended to by staff when they visited people living at the home. They also told us the staff communicated very well, they listened to advice and always carried out any instructions they left. They said the home always acted promptly and professionally and made referrals to their service in a timely way. Hygiene at the home was reported to be of a good standard and the home always appeared to have enough staff. They stated the staff appeared to work as a team and that any information the home shared was relevant and good.
The provider had a robust auditing system in place to monitor quality assurance. Records demonstrated any identified issues were acted upon in order to make improvements. The registered manager and provider had systems in place to obtain the views of people who lived at the home and their relatives.
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 29 July 2019) 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 and the provider was no longer in breach of regulations.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe and Well-led which contain those requirements and Effective due to its rating of requires improvement.
The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion but were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
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 COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langdale Nursing Home on our website at www.cqc.org.uk.
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.