The Langleys

The Langleys is a residential care home providing the regulated activity of accommodation for persons who require nursing or personal care up to a maximum of 15 people. The service provides personal care support to older people aged 65 and over. At the time of the inspection the service was providing personal care for 11 people.

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

Lessons had not been learned, because the provider continued to fail to ensure people living at The Langleys always received safe, high-quality care. Whilst some improvements to benefit people since our last inspection, progress to implement all the required improvements had not been sufficient. The provider remains in breach of the regulations, and as a result, people remained at risk of harm.

People had individual care plans describing the care and support they needed, but risk management was not clearly demonstrated to show people’s needs were met safely and effectively. Infection control practices needed improvement to ensure people were not placed at risk of infection. People's medicines were not always managed safely. Medicine records did not clearly show how medicines had been managed. Staffing arrangements were not clearly demonstrated to show they were effective in managing risks and keeping people safe. Staff completed periodic training but records of this were not sufficient to confirm training was up-to-date and appropriate.

Some practices within the home did not promote people’s privacy and dignity. The lack of maintenance and attention to environment was not demonstrative of respecting people's dignity. Staff and people using the service had good relationships and staff were caring in their approach to people. People and their relatives told us they felt staff were caring and supportive and communicated with them well. People were supported to have 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 were involved in making everyday decisions linked to their care.

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 20 February 2020). The service remains rated Requires Improvement. 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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions safe, and well-led which contain those requirements. We also reviewed the caring key question due to our findings during the inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed. We have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Langleys is a residential care home providing personal care for up to 15 people aged 65 and over. At the time of the inspection the service was providing care for 11 people.

People’s experience of using this service

The registered manager and provider had systems in place to monitor the service, but these had not been fully effective. This was because risks associated with people’s care and the environment were either not identified or managed effectively. This included management of fire risks.

People’s medicines were not always managed safely. Records were not sufficiently clear to demonstrate medicines had been administered as prescribed.

Staff knew the safeguarding reporting procedures and felt confident to immediately report any concerns that could suggest potential abuse. However, an incident reported to the registered manager and provider had not been reported to us or the local authority as required.

Staff were not fully aware what accidents should be recorded and reported to the relevant agencies to enable any risks to people to be followed up and investigated as appropriate.

People had individual care plans describing the care and support people needed, but they did not always include some important information specific to the person. People did not always receive care that met their needs and preferences. For example, people wanted more activities to be provided.

Staff recruitment information was provided retrospectively and did not show thorough checks of information provided by employees had been completed.

Staff and people using the service had good relationships. Staff were caring in their approach to people. People's dignity was usually maintained, and personal care was carried out in private.

People were supported to have 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.

Staff completed an induction when they started work at the home and also completed ongoing training to ensure they had the knowledge and skills they needed to support people effectively.

People were involved in decisions about their care and made everyday choices linked to their care such as where they spent their time and what food and drinks they wanted. People were positive in their comments about the food provided.

Systems were in place to check the home was maintained in a clean condition and staff were aware of processes to follow to reduce the risk of the spread of infection.

During our inspection staff were responsive to people’s needs and people knew how to raise concerns if they were not happy. There had been no complaints recorded at the time of our inspection.

Rating at last inspection

The last rating for this service was Requires Improvement (published 9 January 2019). This is the second consecutive time the service has been rated as Requires Improvement and prior to this the service was rated inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found two breaches of the Health and Social Care Act 2008. These were in relation to the safe care and treatment of people and good governance. Please see what action we told provider to take at the end of the full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The Langleys 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 Langley’s provides care and accommodation for up to 15 older people. There were eight people living in the home at the time of our visit. In response to the concerns identified at our previous inspection visit, the provider had taken the decision not to admit further people into the care home, hence the reduced numbers of people at the home when we visited.

At our last inspection in February and March 2018 we found there were improvements needed in all the key questions we inspected these were Safe, Effective, Caring, Responsive and Well led. There were five breaches of regulations at that time and we rated the service 'Inadequate' overall. The service was placed into ‘Special Measures’. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as ‘inadequate’ overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service is required to have 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 and associated Regulations about how the service is run. The previous registered manager had left their employment in August 2017. A new manager had been in post for approximately 11 months. They had submitted an application to apply to register with us and this was under consideration.

Systems and processes to monitor the quality of the service had improved from the previous inspection. Action had been taken to address the high-risk fire safety concerns previously identified. However, there were some health and safety risks and risks associated with people’s care that had not been sufficiently addressed. This included risks associated with staff recruitment as procedures in place had not been followed to ensure staff were recruited safely.

Information about how staff should manage risks associated with people’s care was not always clear although staff knew people well and were aware of these risks. Some care records did not contain accurate information but they were more detailed to help staff provide care and support in accordance with people’s wishes and preferences.

People received their medicines when they needed them and action had been taken following the last inspection to improve medicine storage. Some improvement was needed to medicine records to ensure risks associated with medicine management were safely managed.

There were enough staff on duty to meet people’s needs in a timely way and people were positive in their comments of the care and support they received. Staff told us they had completed training they needed to carry out their role but training records needed improvement to demonstrate this.

Both people and staff spoke positively about the manager and provider and people told us they felt safe living at the home. People told us about improvements made to décor and further improvements were planned.

The home was clean and staff understood what action to take to protect people from the risk of infection.

People told us there was now more to do to occupy their time. The frequency and range of social activities had increased so people had more opportunities to engage in activities they enjoyed. Activities to support people living with dementia remained an area for improvement.

Staff understood how to support people’s rights and demonstrated an understanding of the Mental Capacity Act (2005). People’s consent was sought before delivering care.

People were involved in planning their care and were offered choices related to daily living such as times they got up and what meals and drinks they wanted. Staff understood the importance of involving people in decisions and had improved ways of working to support people to maintain their independence. Staff respected people’s privacy and dignity. This was an improvement from the previous inspection.

People and their relatives spoke highly of the staff and about living at the home. People said they enjoyed the meals provided and we saw mealtimes were a more positive experience than they had been at our previous inspection visit. Staff had received nutrition training and knew how to support people with specialised diets to maintain their health.

Quality monitoring processes to obtain feedback from people about the service had improved since our last inspection but auditing systems and checks were not always effective in identifying risks and acting upon them.

The Langleys 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 Langley’s provides care and accommodation for up to 15 older people. There were 10 people living in the home at the time of our first visit and 11 people during our second visit.

At our last inspection in November 2016 we found there were improvements needed in four of the key questions we inspected these were Safe, Effective, Responsive and Well led. No breaches of regulations were identified at that time. We rated the service 'requires improvement' overall. During this inspection improvements had not been made to improve the ratings and we identified additional areas needed improvement. We have therefore rated the service as ‘Inadequate’.

The service is required to have 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 and associated Regulations about how the service is run. Since our last inspection the management at the home had changed. The previous registered manager had left their employment in August 2017. A new manager had been in post for three months at the time of our visit and was in the process of applying to register with us.

Systems and processes had not been established or managed effectively to monitor, assess and improve the quality and safety of the services provided. The provider had not identified or taken action to mitigate risks in relation to the fire safety at the home which placed people at serious risk. We formally wrote to the provider and asked them to take immediate action to reduce these risks. Sufficient action was taken and this was confirmed by the Fire Safety team. Some health and safety risks in the home had not been identified and managed to keep people safe. The home was not clean and staff practices did not always protect people from the risk of infection.

Most people received their medicines when they needed them but the storage of medicines was not safe. Medicine audits took place but had not identified areas that required improvement.

Risk assessments to manage risks associated with people’s care were not effective. Some information recorded was incorrect and important information was not always available to support staff to provide safe, consistent care.

There was not enough staff on duty to meet people’s needs in a timely way. The system the provider used to assess how many staff were needed to support people safely was not effective. Staff had not completed all of the training they needed to meet people’s individual needs. Staff members spoke positively about the manager and provider but told us they would feel more supported if more staff were on duty.

People’s rights were not always protected because the provider continued not to work in line with the requirements of the Mental Capacity Act (2005). Staff did not demonstrate to us they understood the principles of the MCA but they did seek peoples consent before they provided assistance.

The provider did not understand the requirement of their registration which placed people at risk of harm. Assessments of people’s needs took place before people moved into the home but these assessments had not gathered enough information to ensure people’s needs could be met at the home. People told us they had not been involved in planning and reviewing their care.

The information contained with people’s care plans was not sufficient to support staff to provide care in-line with people’s preferences and wishes. The arrangements to check the quality of people's care plans were not effective. The manager did not demonstrate they understood people’s needs. We were not assured the manager had sufficient knowledge of best practice and legislation to continually improve the service provided.

People’s privacy and dignity was not always maintained. Staff did not understand the importance and principles of equality and diversity as part of a caring approach. Staff did support some people to be as independent as they wished to be. However, the layout and facilities at the home were not suitable to meet some people’s needs.

People told us there was not enough to do to occupy their time. We found no improvements had been made the social activities provided to people since our last inspection.

People provided positive feedback about the food but we saw the mealtime experience was not positive for all people. Staff did not demonstrate they understood how to provide specialised diets.

There were ineffective systems to seek feedback from people about the service they received to drive forward improvements. It was not evident the home worked in partnership with the local community to enhance people's lives.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care, should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

In response to the concerns identified, the provider has taken the decision not to admit further people into the care home until improvements are made. Local Authority commissioners are supporting the provider to bring about improvements required.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During our last inspection on 6 October 2014, we found the provider was not fully meeting the standards required. This applied to the standards related to “Effective” and “Well Led”. This meant we allocated an overall rating of “Requires Improvement”. During this inspection we found that whilst some improvements had been made and overall people were happy with the service they received, some areas continued to need improvement and additional areas for improvement were also identified.

There was a registered manager in post who was registered with us in July 2015. This manager had previously worked in the home in the registered manager’s position for several years but had left and returned. 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 living at the home. The provider carried out a range of recruitment checks to ensure staff employed were safe and suitable to work with people. Risks associated with people’s care had been identified but records and communication processes were not always clear to ensure staff knew how to respond to risks in order to maintain people’s safety.

Medicines were stored securely but medicine records did not demonstrate people always received their medicines as prescribed. Audit processes had not been effective in identifying errors.

Care staff at The Langleys completed catering duties in addition to providing care to people. This impacted on their time and meant there were times of the day when staff were particularly busy. Despite this, people felt there were enough staff on duty to meet their care needs and there were enough staff to keep people safe. However, staff had limited time to support people’s social care needs to provide person centred care. The atmosphere in the home was quiet with people relaxing either in the communal areas of the home or their rooms. During mealtimes people came together and there was social interaction between people and staff.

People felt staff had the skills and experience required to meet their needs. Staff completed training on an ongoing basis to help them develop their skills and competence to carry out their role safely and effectively. Staff understood their roles but were not always clear what was expected of them in regards to the completion of records. Staff were supported by the registered manager through one to one supervision meetings and staff meetings. People felt staff were caring and were positive in their comments of staff. Staff aimed to support people’s privacy, dignity and independence but this did not always happen.

The registered manager and staff had some understanding of the Mental Capacity Act but the principles of the Act were not always followed. It was not possible to determine whether people had the capacity to make decisions that impacted on their care and people were not always involved in these decisions.

People said they had enough to eat and drink and there were meal choices provided each day. Where people were at risk of poor health, due to not eating or drinking enough, there were processes to monitor their food and how much their drank to help ensure their health was maintained.

Visitors were made to feel welcome at any time to help people to maintain relationships with people important to them. People felt at ease to raise any concerns with the registered manager. However, the complaint procedure had not been updated to ensure people had access to the information needed to escalate concerns further if needed.

Each person had a care plan which contained the information staff needed to meet people’s care needs. Plans did not always contain person centred information to assist staff in ensuring people were supported in accordance with their wishes and preferences.

There were systems to monitor the quality of the service and drive improvement within the home. The provider was in regular contact with the home so they could monitor the quality of care and service provided. People and staff spoke positively about the home but quality monitoring did not always identify areas needing improvement.

People and staff were positive in their comments of the registered manager.

We saw people sitting in the lounge watching television or sitting in the dining room reading. People looked well cared for.

People we spoke with were satisfied with the food provided. They told us, 'It's good I suppose, you get a repeat (referring to meals being repeated).' 'That's alright (food).' People told us they could have a drink when they wanted one and we saw drinks being provided during the day. We saw the main meal of the day looked appetising, this was served at lunchtime.

We saw medicines were being stored and managed appropriately. People had been given their medicines as prescribed to maintain their health.

Staff told us they completed training on an ongoing basis. We saw records confirming staff had completed mandatory training such as moving and handling and infection control. The manager had identified where further training was required for staff and this had been arranged.

There were systems in place to manage complaints. Complaints received had been investigated and acted upon appropriately.