Langwith Lodge Care Home

We found the following examples of good practice.

There was a restriction on visiting the service at the time of the inspection. There were procedures in place for visitors to the service, including healthcare professionals and relatives to reduce and prevent the spread of infection.

The provider ensured people maintained contact with relatives by staff supporting them with telephone calls and video calls. The registered manager told us they had accommodated garden visits during the summer. They were reviewing visits for the winter in line with current guidance for accepting visitors. A purpose-built visiting pod was in place to accommodate these visits. This was bookable by appointments to reduce the risk of spreading COVID-19.

There was a clear regular programme for staff and people living in the home to be tested for COVID-19. This meant swift action could be taken if or when positive tests were received.

Staff followed procedures for putting on and removing personal protective equipment (PPE) and disposed of it safely, in line with the government guidelines. All staff wore appropriate PPE, which was in good supply. Posters and information about COVID-19 and washing hands were displayed throughout the service. The provider was working with Public Health England and felt fully supported by the local authority to ensure the service had appropriate infection control measures in place.

Robust risk assessments and contingency plans were in place and used when staff or people had tested positive or had to self-isolate. There were arrangements in place to deploy staff across the service to reduce the risk of cross infection. Agency staff were used to cover shortfalls in staffing, due to staff testing positive for COVID-19.

Handover meetings were completed in line with safe distancing guidelines.

A generic risk assessment was in place for people in high risk groups. The registered manager shared examples of what impact this would have for people. They had also completed wellbeing assessments for all staff and assured us that adjustments to staff working practices would be put in place as and when required to keep them safe. Staff who were noted at higher risk of the infection were shielding at this time.

People using the service had tested positive and had isolated in their own rooms. Arrangements were in place to reduce the spread of infection. Peoples individual needs were considered to ensure everyone was kept safe.

The home was very clean and the provider had a refurbishment programme in place. Housekeeping staff had increased the cleaning regime. The cleaning schedules had been consistently completed for the weekly and monthly tasks around the home environment. Deep cleaning had been implemented and increased as people came out of isolation to reduce the risk of spreading infection.

Langwith Lodge is a residential care home providing personal and nursing care to 52 people aged 65 and over at the time of the inspection. The service can support up to 54 people.

The care home is a large country house that has been adapted for its current purpose. It accommodates people across three floors. The ground floor accommodates people who are more independent. There is a small suite on the first floor which specialises in providing care to people living with dementia, and six bedrooms for people on a top floor. Some bedrooms are double and accommodate couples. It is set in village location with a large garden, woods and a lake.

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

People told us they felt safe with the care and support they received from staff. Staff understood their responsibility to protect people from harm and knew how to identify and report abuse.

Staffing levels were adequate and determined by people’s needs. Relatives told us there were always enough staff around. People received their medicines in a safe way, and staff recruitment checks ensured staff were suitable to support people. Staff told us they received appropriate training and support for their roles.

Peoples nutritional and healthcare needs were assessed and well managed. People were protected against the spread of infection by staff that were trained in infection control.

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.

People and families told us staff were kind and caring and treated them with respect, and people had the opportunity to be involved in the development of the service. Peoples wishes regarding end of life care required further discussion to ensure staff understood their preferences.

The provider had good systems in place to monitor the quality of the service provided to drive improvement. People had access to the provider’s complaints procedure.

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 Good (17 June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

On the day of our inspection there was a registered manager in place. 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.

During our previous inspection on 28 and 29 July 2016 we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the assessment of people’s care and support needs when they lacked the capacity to make their own decisions. During this inspection we checked to see whether improvements had been made and we found they had.

The principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had now been followed when decisions were made about people’s care.

People were supported by staff who completed an induction prior to commencing their role. They had the skills and training needed and their performance was regularly reviewed to enable them to support people effectively. Staff felt supported by the registered manager.

People were supported to maintain good health in relation to their food and drink. People’s day to day health needs were met by staff and referrals to relevant health services were made where needed.

Staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed. There were enough staff to keep people safe and to meet their needs. People’s medicines were managed safely. Protocols for the safe administration of ‘as needed’ medicines were in place for most but not all of these medicines.

Staff were kind and caring and provided people with dignified, respectful and compassionate care and support. Staff responded quickly to people when they showed signs of distress or had become upset. Staff understood people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained, although two toilets did not have working locks. People felt staff treated them with respect. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates. People’s friends and relatives were able to visit whenever they wanted to.

There were opportunities for people to take part in the activities that were important to them, with people’s views regularly requested on how further improvements to the activities could be made. People living at the home had detailed person centred care plans in place that recorded their preferences and likes and dislikes. Staff were knowledgeable about people’s preferences. People were provided with the information they needed if they wished to make a complaint and they felt their complaint would be acted on.

The registered manager led the service well and was respected and well-liked by all the people we spoke with including visiting health and social care professionals. People were encouraged to provide feedback about the quality of the service and this information was used to make improvements, although an action plan had not yet been formed following the most recent results. The continued development of staff and the registered manager’s performance was a key aim of the provider. Quality assurance processes were in place to ensure people and others were safe in the home.

A manager was in place and been in post since May 2016. They were not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. An application for the manager to become registered has been received by the CQC. We will monitor the progress of the application.

During our previous inspection on 19 November 2015, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; the appropriate application of the Mental Capacity Act 2005, the management of people’s medicines and the management of the home.

During this inspection we checked to see whether improvements had been made. We found some improvements had been made, but further improvements were still required.

People told us they felt safe living at the home. Staff understood how to identify and report allegations of abuse. The assessment of the risks to people’s safety were carried out, however some of these records required more regular review. Accidents and incidents were appropriately investigated and assessments of the environment people lived in were carried out to ensure it was safe.

The processes for the safe management of people’s medicines had improved, but further improvements were required. This included ensuring that the processes where people received their medicines ‘as needed’ were in place for all and ensuring regular checks of the temperature of the room and fridges the medicines were stored in were also carried out. People and relatives gave mixed feedback about the number of staff in place. We observed an appropriate number of staff to support people, although there were periods of time during the inspection where there was limited staff presence in communal areas.

Improvements had not been made in the way the principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had been followed when decisions were made about people’s care. There were very limited examples of MCA assessments having been carried out. There were also insufficient numbers of applications to the appropriate authorising body to legally deprive people of their liberty.

People were supported by staff who had completed a detailed induction and training programme. Some staff required refresher training in some areas. Staff received regular supervision of their work. People spoke positively about the food provided at the home and we observed an organised lunch time experience. People’s day to day health needs were met, but records used to support staff with doing so were not always in place or recorded in sufficient detail.

People were treated with respect and dignity by staff. People felt staff were kind and caring and respected their privacy. People’s records contained limited information about their life history; however plans were in place to address this. People were involved with decisions about their care and support needs. People were encouraged to lead independent lives. Information for people on how to access independent advice about decisions they made was available but not easily accessible.

People’s care records contained care plans to support staff with providing responsive care. However, these records were often either not fully completed or did not reflect people’s current support needs. People and relatives felt the activities provided at the home required improving. We were told by the manager the number of hours the activities coordinator now worked had increased to improve this. People felt able to make a complaint and were confident it would be dealt with appropriately.

The manager’s auditing processes had improved since the last inspection, but further work was required to ensure the issues raised within this report were identified and addressed in a timely manner. The manager was aware of their responsibilities to inform the CQC of incidents that could affect people’s lives. People, relatives and staff spoke highly of the manager. People were encouraged to become involved with development of the service and were given the opportunity to give their opinions during ‘resident meetings’ and via questionnaires. However improving people’s and relative’s awareness of these was needed.

We identified one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

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 at the home and that there were enough staff to support them. However relatives and staff felt more staff were needed at busy times. People were supported by staff who could identify the different types of abuse and knew who to report any concerns to.

The risks to people’s safety were not always appropriately assessed and well managed and were not always regularly reviewed. Evacuation plans for one person had not been reviewed and did not reflect their current needs. Where people had been involved in an accident or incident at the home the incident had been recorded and reported to the registered manager and had been investigated. People’s medicines were not always safely managed or stored securely and there were some errors with recording of what medicines people had been administered.

The registered manager did not always ensure the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguard had been appropriately applied.

People had access to external healthcare professionals however the guidance and recommendations made by them were not always implemented. People spoke positively about the staff and were supported by staff who received supervision which assessed the quality of their work. However some staff had only received one supervision in the last eleven months. The majority of the staff training was up to date; however there were a small number of areas where refresher training was needed. People we spoke with told us they liked the food and drink provided at the home. Some relatives felt more staff were needed to support people during meal times.

People felt the staff were kind and caring and treated them with respect. Information for people on how to access independent advice about decisions they made was not available. Other information about external health and social care services was also not available. People told us they felt included in decisions made about their care and support although people’s records did not always reflect this. There were positive examples of staff treating people with dignity and respect although we also saw some poor interactions. People were encouraged to do as much for themselves as possible and staff understood people’s likes and dislikes.

People’s care records contained an initial assessment of their needs however once care plans were in place they were not regularly reviewed. Staff were provided with some people’s life histories to enable them to use this information to support people. However this was not in place for all. People spoke positively about the activities at the home although there was a lack of information available to inform people what activities were available to them. People felt able to make a complaint if they needed to but information about the process was not fully available and was provided in a format that some people may find difficult to understand.

The registered manager did not have auditing processes in place to monitor the risks to people’s care and support needs and the service as a whole. The registered manager ensured that the CQC were provided with the appropriate statutory notifications, however one of these did not contain an accurate account of an incident that had occurred. People were encouraged to become involved with development of the service and were given the opportunity to give their opinions on how things could improve. Relatives told us they thought the quality of the service had improved since the registered manager started working at the home. However some staff members felt the registered manager was not always approachable.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

During this inspection we met and spent time with five people who used the service. Two of these people were unable to answer direct questions and tell us directly about the care they received due to their condition. We gained information about the service from reviews of care records and discussions with; four relatives, two care workers, one senior care workers, the care home manager, the deputy manager, and the provider's general manager who was responsible for overseeing the service provided at each of their care homes. Below is a summary of what we found.

Is the service safe?

People told us they felt safe at the care home. One person said 'I always feel safe.' All of the relatives we spoke with said they trusted staff and were confident about raising concerns or complaints with the home manager if required.

We saw from records that staff received regular compulsory training to ensure vulnerable adults were protected from the risk of abuse. Staff we spoke with told us how they would identify and alert any concerns about abuse to managers. They were aware of the role of local authorities and the police in investigating concerns about people who may be unsafe or suffering abuse.

Staff were aware that people who lacked the capacity to decide and agree how their care was provided were at risk of being cared for in ways which could fail to represent their human rights. Senior staff were aware that where these risks existed the person should be referred for independent assessment under a law called the Deprivation of Liberties Safeguards (DoLS). This assessment determines whether the care provided or planned is necessary and in the person's best interests. We saw from records and discussions with the manager that the service knew how to apply for DoLS assessments.

We saw potential risks to people's health and safety had been identified and assessments completed. We also found that care was designed and delivered in ways intended to reduce these risks. We noted that effective systems were in place and action was taken to ensure people received care in clean and safe environment.

Is the service effective?

People told us they felt the care offered was helpful and effective. One person told us they received, 'Marvellous' care. A relative we spoke with said the care of their relative was, 'Very good.'

We saw from records and people told us they were appropriately consulted about the care they received. We noted people's wishes and choices were clearly written in care plans which were regularly reviewed and updated.

We saw from records that the service worked closely with health and social care professionals to ensure people received prompt and effective care.

Is the service caring?

One relative told us, 'Everyone (at the home) is very caring.' A person who used the service said, 'The staff are all very good'

Throughout our inspection visit we observed warm and positive interaction between staff and people who used the service.

Staff we spoke with had a good awareness of the needs of people they supported. We saw people were spoken to using the preferred names recorded in their care files. Care records included information from conversations with people about their lives, aspirations, interests and wishes.

We noted that trips and activities were organised to take account of the interests and wishes of both individuals and groups. Two people we spoke with told us about trips they had enjoyed to places with special significance and memories for them.

Is the service responsive?

We noted the service responded positively to concerns raised at the last CQC inspection in January 2014. We saw during this inspection they had effectively addressed each of the specific concerns identified and had maintained improvements in these areas.

The service sought people's views through questionnaires, family meetings and informal consultation with families and people who used the service. We saw from audits that proposals and suggestions raised by people were listened to and implemented. One specific issue regarding the replacement of flooring to tackle an unpleasant odour had been actioned. New flooring had been purchased and according to managers would be installed shortly.

Is the service well-led?

People who used the service, their families and staff we spoke with told us the service was well led by the current management team. One person told us they felt positive about the manager stating, 'I think she's on the ball.'

The service reviewed and evaluated a range of health and safety systems to ensure the home was clean, well maintained and safe for people to live and work in. These audits included detailed cleaning and maintenance schedules which were generally well managed and recorded.

Staff told us the supportive attitude of colleagues and the manager helped ensure challenges they faced in their day to day work were manageable.

Creative approaches to engaging the interest and involvement of people who used the service and their families included family meetings and a 'wishing tree' to which people tied ideas that might improve the service they received. These ideas were designed to help improve the quality of the service and lives of the people who received care.

We found that people received food and drink that was suitable to their needs. A person who used the service told us, 'The food is great, you get a choice of things to eat, no complaints.'

We found that whilst the home was generally clean and tidy there were not always adequate facilities to prevent the spread of infection in people's bedrooms and on two of the three floors of the building.

Medicines were stored and administered safely. A relative we spoke with told us, 'My mother was on anti-sickness tablets, the staff explained what they were for and she seems a lot better now.'

Staff were trained on the use of specialised equipment. People who used the service felt safe when staff used the equipment to support them. One person who used the service told us, "I need an electric hoist for the bath; the staff know what they are doing.'

People were aware of how to complain and felt the manager would act on their complaint. A relative we spoke with told us, 'I have seen the complaints procedure in my mum's service user guide. From what I've seen the home is well run. You can go to the manager and they sort things out quickly.' Some of the information made available for people explaining how to complain required updating.

We looked at service information, records and carried out a tour of the building.

People told us they were asked for their consent prior to care or treatment. One person told us, 'I am in charge of my life. They (staff) will only do what I ask them to. I am very satisfied."

All of the people we spoke with told us they were happy with the care, treatment and support they received. One relative told us, 'I wouldn't have left them there if I wasn't satisfied; the place is amazing.'

People told us they felt the premises were safe and well maintained. One person told us, 'Everywhere is clean and I like how it is decorated.'

The majority of the people we spoke with told us there were enough qualified, skilled and experienced staff to meet people's needs.' One person told us "The staff help me with the things I find difficult to do myself, the manager is marvellous.' Another person said, 'I think sometimes they could do with another one [another care staff member on duty].'

People we spoke with told us the staff made them feel protected and safe. One relative told us, 'They (staff) make the residents feel special.'