Archived: Langley Oaks

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This service was previously rated good. This key question has been rated good overall. This meant people’s needs were met through good organisation and delivery although people were not always were not always involved in planning for their care.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care choices and did not always work in partnership with people. People or their relatives were not always involved in planning their care.

We spoke to people’s relatives and feedback was mixed. For example, one relative told us, “I haven't seen my [relative’s] care plan” and another relative told us, “I've not really been involved in developing her care plan.”

The provider held both electronic and paper care records. We reviewed samples of both methods. Care plans held on the electronic records described people’s needs but were not developed in partnership with people or their relatives and were not always written in a person-centred way. For example, we looked at 2 care plan records and the expected outcomes were not individualised or specific, using phrases such as “comply with medication,” “ensure care is given in best interests” and “to reduce falls and prevent injury.” Care plans were reviewed regularly; however, information was not always appropriately updated. We reviewed 8 care records, and 2 records referred to medicines’ information, however, there had not been a medicines review in over 12 months. For example, a care plan referred to the last medicines review being in November 2023 and this information had not been updated since to accurately reflect the current medicines prescribed. We were told this may be due to previous information being carried across from monthly care plan reviews and was overlooked when the care plan was later reviewed. Care plans were not signed by people, their representatives or staff. The provider did not consistently include people or their relatives in discussions about peoples’ care plan goals and desired outcomes. Outcomes were task driven and informed care staff how to meet people’s needs however, we could not be assured people were at the centre of their care and the provider was working in a person-centred way.

This was a Breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 .

The provider worked with other professionals to ensure people’s needs were appropriately assessed prior to admission, and transitions were safely managed.

The provider worked with multiple care agencies including social services, hospitals, district nurses, GP surgeries, pharmacies, opticians and a chiropodist. A relative told us, “A district nurse needed to visit to change [relative’s] dressings. The staff arranged all this, and it was done effectively.”

We checked peoples care records and saw the provider mostly ensured people’s needs were assessed and met, including by working with specialist agencies to support people’s health and wellbeing. Where the provider worked with other specialist agencies peoples’ needs were assessed and met.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider used an app to keep people’s relatives informed about their day-to-day engagement with the home’s activities. The registered manager told us she had written to each person’s relatives or representatives to introduce herself as the new home manager, with future plans to meet with relatives individually. The registered manager held regular residents’ meetings which relatives were invited to join. Minutes and actions were recorded. Within the service there were notice boards and staff spoke to people about events of the day and meal choices, including using picture boards. People’s communication needs were recorded in their care records, and access to other professionals such as opticians were facilitated to ensure individual needs were met.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care and support. Staff involved people in decisions about their care and told them what had changed as a result.

People’s relatives felt confident the service would take appropriate action if they raised a complaint. A relative told us, “I think that they would take complaints seriously. If I have an issue or complaint, I will tell staff, then the manager and then back up with a letter.” Another relative said, “I know that this home would take complaints seriously.”

The provider had a complaints policy as well as annual surveys for relatives and staff, to gather anonymous feedback. Staff told us they knew how to manage concerns or feedback from people, and how to escalate it to their manager. The registered manager explained how they managed complaints and communicated outcomes to people. The mangers gave examples of how they ensure learning is shared with staff to improve the service, through post incident debriefs, team meetings and where appropriate, one-to-one meetings.

The provider had a complaints log and folder which demonstrated how concerns were investigated, lessons identified, and outcomes were provided in writing to people’s relatives. The registered manager was able to demonstrate how they worked with other statutory agencies when it was appropriate to do so as part of this process.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

A relative told us, “I can visit whenever I want” and there were visitors onsite on both days during our assessment. The registered manager told us visiting hours were not restricted, and relatives were encouraged to stay overnight when appropriate.

The service was purpose built and accessible and people living there were not restricted when moving about the home. Bathrooms were adapted and staff provided people with choice if they preferred a bath instead of a shower. People had access to GP appointments on site, as well as a hairdresser, and could access the garden with support if they needed it. The home was staffed 24 hours a day and supported by the on-call manager out of hours. Staff had access to out of hours medical advice and support. A range of equipment was available to meet people’s needs.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Relatives told us the service was inclusive and celebrated difference. For example, a relative said, “They do a lot of cultural activities, such as speaking with [relative] in [their first language].” The home was welcoming and celebrated difference in its artwork, and through activities and music. People’s relatives told us the activities were varied and inclusive, including celebrating events such as Jamaican Independence Day and VE Day. The service employs an activities co-ordinator and has a team leader currently assigned as a resident’s companion to support people on an individual basis. However, we reviewed care records which showed some residents had less opportunity to engage in activities than others, especially those who spent time in their rooms or who were cared for in bed. Relatives told us they would like to see more dementia friendly activities and more trips out into the community. People’s relatives told us, “They used to take residents out for day trips, for example to Brighton and garden centres. The registered manager said that although the people carrier was still there, there was no driver to drive it.” Another relative said, “There used to be a lot of lavish activities too, which would have cost a lot and don’t seem to be happening now. I wondered if there has been a financial issue. The level of outside activities has fallen since too.”

The provider had policies, and staff had attended training, to promote best practice in equality, diversity and inclusion. Staff reported they felt treated equally.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We reviewed 8 care records and noted 2 people’s end of life decisions were not regularly reviewed or revisited. One care record documented a discussion about advance care planning over 18 months ago and that this decision should be revisited. This had not been followed up, which meant information relating to this person’s end of life choices and wishes were not known. Another care record documented a DNAR (Do Not Attempt to Resuscitate) discussion but stated the person could not decide. An action was documented for care staff to arrange an advocate to support the person to plan, but this had not been followed up. This meant people’s advanced care decisions were not always supported and inclusive of their wishes. This put people at risk of not receiving appropriate and timely care in line with their future wishes because this information was not always documented and communicated to the staff caring for them.

Care staff had completed e-learning on end-of-life care; this training was a one-off requirement, and was not refreshed.