Langfield Nursing and Residential Home

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. The ones that applied to the area this home was located were commonly known as 'Tier Three Rules'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

We noted good practices in all of the areas we considered including the use of and disposal of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly and there were robust procedures in place around the use of PPE.

The provider and registered manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Where appropriate, and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions with infection outbreaks, these visits had been restricted and were only allowed in exceptional circumstances. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.

We noted the provider and registered manager were developing a visiting area in a suitable location. This would incorporate shielding and isolation processes to ensure visitors and residents were protected. The registered manager said that this would only be used when guidance allowed and the current rules were relaxed.

Visiting rules and process were communicated effectively to people using the service and their relatives. People were also supported in contacting their friends and relatives by the use of social media and video messaging services. This assisted in promoting people's mental wellbeing.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. The registered manager insisted people were tested before admission and consistent with guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

Staff had comprehensive knowledge of good practice guidance and had attended Covid-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Areas of the home could be segregated in the event of widespread infection so as to assist with appropriate isolation of people. The registered manager said separate staff members could be used to help in this situation.

Policies and infection control processes were regularly reviewed when guidance changed. We saw good examples of this that took into account guidance from a wide variety of sources. The provider kept abreast of developments and changes and we saw examples of where they had considered new guidance and provided this to management and staff in the home.

The home was clean and hygienic. The service had a designated cleaner. All staff had received Covid-19 related supervision and the registered manager was proactive around ensuring staff had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Langfield Nursing and Residential Home is a residential care home which can personal care to 54 people. At the time of the inspection the service was full.

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

People told us they felt safe at Langfield Nursing and Residential Home. Staff understood safeguarding procedures and any risks were identified and well managed. Staff were attentive to people’s health needs and diligent when administering medicines. Regular checks ensured the premises were clean and provided a safe environment.

The service worked within legislative guidelines. Staff were well trained and pre-assessments and reviews ensured they could meet the needs of the people who lived at Langfield. People told us they were offered choices. Where people lacked capacity, assessments ensured that any restrictions placed on people were in their best interests and the least restrictive option. People told us that the staff were mindful of their dietary needs and that they liked the food provided.

Care staff were kind and caring in their interactions and knew people’s needs and preferences. They communicated easily and comfortably with people and their families, which helped create a pleasant atmosphere.

Detailed care plans were person-centred. They addressed individual needs and people and their relatives had a say in how their care wasis delivered. Staff were vigilant to any changes in people’s needs.., and reviews ensured that staff could respond quickly to any of these changes. Care records included information about people’s hobbies and activities reflected people’s interests. Complaints were well managed, and when upheld there was evidence of action to minimise future errors.

The provider maintained a good oversight of the service which was well led by a manager who was highly involved in the day to day running of the service. They had built an open and welcoming service where people felt happy with the quality of their support. There was excellent communication with people and relatives on a regular basis, and people felt that they could influence how their care was delivered. Staff felt supported and that their hard work was rewarded. They were proud of the care they delivered.

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 (published 10 April 2017).

Why we inspected

This was a planned inspection based on our current methodology.

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.

This was an unannounced inspection which took place on the 28 February 2017.

The service is required to have a registered manager in place. There was a registered manager in place at Langfield Nursing and Residential Home. 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. The registered manager was present during this inspection.

People told us they felt safe at Langfield Nursing and Residential Home. Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service. They told us they were certain any concerns they raised would be taken seriously by the managers in the service.

Robust recruitment procedures were in place which ensured staff had been safely recruited. Staff received the training, support and supervision they needed to carry out their roles effectively.

All the people we spoke with were positive about the support they received and felt staff were very respectful, friendly, caring and kind. We saw staff instigated and encouraged conversation and found staff to be vigilant and caring. The registered manager and all the staff we spoke with were able to tell us about the people who used the service. Staff spoke with compassion about people who lived at the home.

People who used the service we spoke with indicated they experienced no restrictions accessing choices. People who used the service and their relatives told us the service was responsive and staff were flexible in meeting their needs.

People’s support needs were assessed before they moved into Langfield Nursing and Residential Home. Care records were written in a person centred way and contained sufficient information to guide staff about people’s support needs, likes and dislikes, preferences and routines. Risk assessments were in place for people who used the service and staff. Care records we saw had been reviewed regularly and had been updated when people’s support needs had changed. People and their relatives had been involved in planning and reviewing the care provided.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow to ensure people received medicines as prescribed.

The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

The home was clean, well-kept, smelling fresh and was brightly lit and well decorated. People’s bedrooms were personalised and contained personal objects and photographs. The home had recently had improvements to the decoration, flooring and furnishings in communal areas and some bedrooms. The first floor had been designed to support people living with dementia orientate themselves. This included differently coloured bedroom doors, big pictures on the walls and memory boxes on individual doors. This helped people identify where their bedroom was, and other areas of the home, and so promote their independence.

Accidents and incidents were appropriately recorded. Health and safety checks had been carried out and equipment was maintained and serviced appropriately.

People had their health needs met and had access to a range of health care professionals. People at risk of poor nutrition and hydration had their needs regularly assessed and monitored. The food within the service was nutritionally balanced and plentiful. All the people we spoke with told us the food was good. One person we spoke with said, “I like my food, there is always choice and options with lots of snacks.”

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was meeting their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

During our inspection we saw lots of visitors coming and going. Visitors we spoke with said they were made to feel very welcome.

There was a range of activities available for people to reduce social isolation and encourage people to be active. One person told us, “I like to mix with others, have a laugh, I enjoy sing-alongs.”

We saw there was a system for gathering people’s views about the service. There was a system in place to record complaints and the service’s responses to them. People we spoke with were aware of the company complaints policy and were very positive about the way the service responded to their concerns.

There was a good system of weekly, monthly and annual quality monitoring and auditing in place to help improve the quality of the service provided.

Everyone we spoke with was positive about the service and the way it was managed. People told us the home had improved, was well managed and that the management and staff were very approachable. Everyone we spoke with was positive about the registered manager. During our inspection we found the registered manager to be open, caring and committed to providing a good quality, caring service.

Staff told us they liked working at Langfield Nursing and Residential Home and felt supported in their work.

The service had notified CQC of any DoLS authorisations, accidents, serious incidents and safeguarding allegations as they are required to do.