Langham Court

We found the following examples of good practice.

People were supported to receive visitors safely. All visitors were required to complete health screening checks in line with current COVID-19 guidelines. Visiting areas had been arranged both inside the home and within the grounds.

Appropriate arrangements were in place to test people, staff and visitors for COVID-19 in line with current guidance. The provider had ensured staff had access to personal protective equipment (PPE) and had received training in how to use and dispose of this safely. We observed staff wearing PPE correctly during our visit.

Langham Court was clean and hygienic throughout. Appropriate cleaning products were in use and the provider had invested in a range of cleaning and air cleansing systems to minimise the spread of infection. Handwashing facilities and hand sanitisers were available throughout the building. Infection control audits were completed which included assessments of staff hand hygiene practices.

There was a continued emphasis on creating a homely environment despite the restrictions in place. Staff continued to support people to socialise and engage in their hobbies and interests whilst encouraging people to maintain social distancing.

Langham Court is a care home with nursing and provides care and support for up to 29 mainly older people living with dementia or mental ill health. It is set next to a general nursing care home, operated by the same provider, although registered separately.

Langham Court is a purpose-built service designed to meet the needs of people living with dementia and providing care over two floors. The service is an accredited ‘Butterfly home’. This is a well-respected non-medical model of dementia care practice.

People’s experience of using this service:

Langham Court is an award-winning service, both for dementia care practice and the quality of the environment. In the months before this inspection the registered manager in place at the last inspection had left. A new experienced manager had been appointed and was starting in September 2019. Interim arrangements and professional consultancy had minimised the impact of the lack of a registered manager, until the new manager was in post.

Quality assurance systems and regular audits were in place to assess, monitor and improve the quality and safety of the service, and ‘people’s voice’ was heard at all levels of the organisation. Effective communication systems were in place, from director level to all staff. The culture, values and philosophy of the service was well understood and demonstrated by all staff we met.

The service had a calm, happy and uplifting atmosphere. People were engaged with activities that interested them, including classical music concerts, Tai Chi and exercise groups. People told us it was a positive place to live and we saw and received feedback from relatives that told us how the service had supported both them and their relation.

The care environment had been developed in line with best practice for people living with dementia. This had contributed to people’s well-being and included many areas where objects of interest meant people could stop and spend time engaging with them. Communal areas and bedrooms were light and spacious. The service had attractive safe outdoor space where people could be involved with gardening projects, or just enjoying the views of woodland, birds and sheep. Links with the local community were encouraged. Visitors were welcomed at any time, and local schools, nurseries and playgroups were regular visitors to the service.

Risks to people from living with long term health conditions were assessed, and people received their medicines as prescribed. Risk assessments included risks such as from falls, poor nutrition or pressure ulcers, and included actions taken to mitigate risks where possible. Where people were at risk, for example from poor nutrition or hydration additional supplementation to meals could be provided. People told us they enjoyed the meals on offer.

People were supported and encouraged to take risks, and remain in control of their lives, supported by thoughtful and reflective practice. Risks within the environment were managed. The service learned from incidents or accidents and reflected on their practice to prevent a re-occurrence.

People’s rights were being respected, and the service respected and supported individual people’s equality and diversity. Decisions had been made in people’s best interests, but these had not always been recorded consistently. The general manager told us this had already been identified and plans were in place to address this. Systems were in place to safeguard people from abuse, and the service responded quickly to any concerns or complaints about people’s wellbeing.

Systems for staff recruitment helped ensure potential staff were safe to work with people who may be vulnerable. High levels of staffing were in place, and this was kept under review. These ensured care staff were available to support people’s needs at all times. Staff were positive about the home’s culture and philosophy and told us how much they enjoyed working in a service where there was enough time to spend with people. Staff received the training and support they needed to carry out their role. This included support for registered nurses to maintain their professional registration.

Care plans were based on assessments of people’s needs. They contained details about people’s wishes and guided staff on how the person’s care should be delivered. We saw people’s care plans were being followed in practice. Staff knew people well. Good end of life care was of a high priority. Staff had clear understanding of people’s needs at this time of their life and had facilities available to help people and relatives to reduce distress.

More information is in the full report

Rating at last inspection:

At their last inspection in December 2016 the service was rated as outstanding for the key questions of caring and well led, and good for the other key questions. The overall rating was outstanding.

Why we inspected: This inspection was scheduled for follow up based on the last report 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.

Langham Court was specifically designed to meet the needs of people living with advanced dementia. There was a clear vision that was centred around the principles of Dementia Care Matters’s Butterfly Household Approach. This is a national scheme aimed at improving the lives of people living with dementia. The service was consistently praised for the positive outcomes staff had achieved to ensure that people living with dementia received exceptional care. The ethos and values of the service created a caring and compassionate environment and ensured that the care delivered was truly focused on meeting the holistic needs of people.

Langham Court was last inspected on 13 January 2014 and there were no concerns.

On the day of inspection we met the registered manager. 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.

The inspection was unannounced and took place on 19 December 2016.

People said that they were safe at Langham Court as they were protected from harm. Staff had the training and the ability to understand risk, and reported accidents and incidents in a timely manner. Staff understood how to report suspected abuse so that action could be taken if necessary.

Incidents and accidents were investigated and the manager reviewed reports to prevent them from re-occurring. Any potential risks to individual people had been identified and appropriately managed.

Risk assessments had been completed to ensure the home was safe for people to live in and there were arrangements in place should there be an emergency.

People were supported by sufficient numbers of staff who were recruited safely and had the skills and knowledge to support people. All nurses had an up to date PIN number to prove they were registered.

Medicines were managed and administrated in a safe way and staff had a good understanding of the medicines they were administrating.

Staff had the knowledge and skills to support people with dementia. Training was available to staff, which included training courses related to people’s needs. When a training need was highlighted the registered manager arranged for it to take place.

The requirements of the Mental Capacity Act were being fully met. Best interest meetings had taken place and the registered manager had submitted Deprivation of Liberty Safeguard applications when people were being deprived of their liberty. The registered manager was aware of the people who could legally make decisions for people who lacked capacity.

People’s nutritional needs were met and people had a varied diet. People were positive about the quality of food served and they had access to food throughout the day. Staff ensured that people had enough to eat and drink.

Staff ensured people were supported to maintain their health and wellbeing and people received support from specialist healthcare professionals when required.

The environment was adapted to support people with dementia. The vibrant and interactive corridors were praised in a recent Dementia Care Matters audit. Equipment had been introduced to help people maintain their independence.

The caring and compassion offered by staff was exceptional. People were cared for by staff who put them at the centre of all they did. People were not rushed by staff and were treated with dignity and respect.

Staff saw people as the individuals they were and supported them in line with their wishes. We observed staff reducing people’s anxiety in a caring and compassionate way. People were encouraged to maintain relationships with their family and those that mattered to them. Countless positive comments were received praising the caring nature and family atmosphere of the home.

People were supported in a very sensitive and person centred way when they were nearing the end of their life. Staff ensured that people had as much quality time with loved ones as they possibly could. The service had introduced an innovative way to support family and friends when people were being supported at the end of their lives. A support tool introduced was praised by specialised nurses.

People were supported by staff who understood and effectively responded to their needs and wishes. There were several initiatives in place, including memory boxes and a wish tree, that were seen to stimulate meaningful conversation that focused on the interests and lives of people.

People had access to a wide variety of activities, which were praised in a recent ‘Dementia Care Matters’ audit. The activity manager had been nominated for a national award for their approach to supporting people with dementia.

People worked with ‘The Way Back’ project to help design an inventive new virtual reality reminiscence tool specifically designed for people with dementia.

People were encouraged to be involved in how the home was run and people and relatives felt comfortable in raising a concern or making a complaint.

The home was led by a manager who was a positive role model. Organisational values providing a family atmosphere was reflected in the support given by staff, the management team and feedback we received. The values of the service was effectively implemented so that people received consistent positive outcomes when living at the service.

A new auditing system had recently been started, which mirrored CQC methodology. When actions had been highlighted improvements had been made, which benefited people living with dementia.

People and staff were empowered to be involved in the running of the service. Feedback was used by the registered manager to improve service delivery.

The culture was open and honest and based on encouraging staff to reflect on their practice. This again went into improving the lives of people living with dementia.

The registered manager and staff worked in partnership with other agencies to effectively enhance the lives of people living with dementia.