Langdale Heights

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

A person-centred approach was taken to the development of care plans and risk assessments. As such, they were detailed, unique to the individual and captured the whole person, their life history, their family and friends and what was important to them. Their views and wishes regarding their care were reflected and embedded into their care plans and risk assessments which had been regularly reviewed and updated. For example, a review of one person’s care plan involved the person and their family member and asked about how the person’s day to day needs were being met, checked they were happy and asked for any suggestions if anything could be done differently. Leaders checked to ensure reviews of people’s care were held regularly. They identified that ‘care reviews are meaningful engagement points and not administrative exercises.’ This helped to ensure people and those important to them were fully involved in care planning and important information about how people wanted to be cared for was available for staff to follow.

People and their relatives told us they were able to contribute to care plans and risk assessments and that they found this valuable. One person told us, “My [relative] is involved in decisions about my care and the care plan. Every 6 months they do it, there is a meeting this week and I am going.” A relative said, “For the care plan they got us involved and asked us [family member’s] likes and dislikes, how they like to dress and what colours they like. We have reviews of the care plan done regularly and if they have any sore skin or a bruise staff will always update us.”

Care plans and risk assessments were updated whenever there was a change in a person’s needs or if there had been a specific incident. For example, a person’s falls risk assessment and care plan had been reviewed in detail and updated following falls. This provided a comprehensive history that showed what other professionals had been involved, for example the community physiotherapist and GP and what actions they had recommended. This showed care plans effectively incorporated advice and guidance from other healthcare professionals into people’s care plans and risk assessments which resulted in consistently comprehensive assessments of people’s needs.

Staff judgements of people’s assessed needs were checked by leaders. Leaders analysed calls made to 999, 111 and any out of hours contacts made by staff. A recent audit found staff had made appropriate clinical judgements and escalated people’s health needs appropriately. Leaders found staff had continued to complete observations and assessments of people’s care, including use of The National Early Warning Score (NEWS2). This is a recognised tool to detect any clinical deterioration in people. This helped to ensure people’s needs were accurately assessed in line with good practice and maintained and used to inform handovers of people’s needs when staff had needed to request further healthcare support for people.

Other recognised assessment tools were used and reviewed regularly and informed people’s care planning. For example, these included assessments for risks associated with falls, skin integrity and frailty. This helped to ensure people’s care was assessed and monitored in line with recognised good practice.

People’s communication needs were assessed and detailed in care plans in a way that emphasised a holistic view to maximise the chances of communicating with people effectively. For example, communication care plans started by identifying how to ensure the person felt safe, secure and reassured. How the environment should be calm and unhurried. Care plans informed staff when people benefited from processing one piece of information at a time, when they preferred the use of short and simple sentences and when they needed enough time to process information and respond. These steps helped to ensure people were given the right support for them to be able to understand information and communicate their needs.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

At Langdale Heights care was person-centred, and holistic, with a strong use of recognised tools and non‑pharmacological approaches to ensure people’s care was effective. They did this by involving people and relatives and those who knew them well in planning their care and treatment. A healthcare professional told us, “They manage challenging behaviour very well. They look at the person’s history and use their interests to calm and distract. They know if the environment is overstimulating. They take the effort to find out what they did for a job. They never ask for sedation.” This meant people were cared for in a holistic approach that acknowledged the importance of environmental and social factors on people’s well-being.

Care was evidence-based. Evidence-based good practice informed the care people needed. For example, the home used the Pain Assessment in Advanced Dementia tool when people were not able to reliably communicate if they were in pain. This relies of behavioural observation rather than people self-reporting pain as a person’s verbal communication can be reduced when they are living with dementia. Using these assessment methods helped ensure people received effective care to manage pain when they were unable to verbally communicate their need for pain relief. Practice was embedded across the service and resulted in positive outcomes for people.

People’s food and drink needs had been assessed in line with the International Dysphagia Diet Standardisation Initiative (IDDSI). This is a framework that classifies food and drink into different levels to improve the safety for people with swallowing difficulties. Relatives told us staff supported their family members well if they had special dietary needs. One relative said, “[Family member] has a smooth diet as last year they had an issue with swallowing, but they are better now.” Staff had information available to them on what levels people needed their food and drink to be prepared to. This helped to ensure staff with responsibility for preparing people’s meals, had information available to them on people’s diet levels to ensure they received effective and safe care.

Staff had ‘Champion’ roles where they took the lead in sharing information with the staff team on areas of best practice. Champions covered areas such as oral care and nutrition. One staff member told us they used a ‘food first’ approach to make sure people received fortified food when needed to help reduce the risks of malnutrition. Staff knew whether people needed additional fortification and provided details of how this was achieved, along with any other food requirements people had and what helped them. Menus were planned in advance and these demonstrated people were provided with a range of options to help them achieve a nutritious and balanced diet. We read a person had given feedback in their recent care review and they said, ‘I am having more fruits and vegetables to maintain my weight. It is working and good for my health.’ People enjoyed their meals and they had plenty of choices and alternatives that supported them to achieve good nutrition.

Clinical supervisions developed and supported staff knowledge and competence when supporting people with their meals and drinks. It emphasised staff were to ensure people were sat upright and to provide small amounts of food at a time and allowed sufficient time for people to eat and swallow each mouthful safely before the next mouthful was offered. We observed staff followed these good practice principles when assisting people with their meals and drinks.

Other clinical supervisions reinforced and developed good practice in the clinical staff group. There was a rolling programme of clinical supervision in place covering a range of relevant areas of care for example, the management of head injuries. This referred to the good practice protocols that should be used, for example the Glasgow Coma Scale (GCS). This is a standardised assessment tool used to assess a person’s consciousness level following a head or brain injury. Other areas of care were informed by appropriate good practice. For example, the use of recognised tools to inform the care required to monitor and guide the prevention, detection and management of pressure ulcers.

Leaders maintained oversight of how risks to people from weight loss were managed. This included monitoring people’s weights either weekly or monthly depending on their need and obtaining input from dieticians. People’s care plans showed their risk from malnutrition had been assessed by using a recognised assessment tool and this helped to inform people’s care based on good practice principles.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs.

Staff at Langdale Heights worked effectively together. We observed staff asked each other for help when needed and they worked as a team to ensure this was provided. For example, staff coordinated between themselves to ensure a staff member was always present in communal areas to help ensure people’s safety when one of them was required to go into a different area.

Staff told us they understood their roles and responsibilities and that information was shared with them, and between them effectively. One staff member told us, “Communication is very good. We get an allocation in the morning. The shift leaders will allocate each member of staff to where they are working.” Another staff member spoke to us about how information was shared when they changed shifts. They said, “We start with the handover from the night to day shift. We discuss the main points, the resident of the day, who is needing encouragement, if their nutrition has been poor and how to encourage them. We have a morning huddle meeting before lunch where we talk about who needs encouragement with fluids et cetera.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The staff team at Langdale Heights were effective at promoting people’s health. For example, one relative told us that previously to living at Langdale Heights, “[Family member] had given up, they were not taking food. Now they have put on some weight, and they look more like themselves.” Multiple staff members told us about another person who had been supported to improve their mobility, and they had now gained more strength and were mobilising independently.

Relatives confirmed staff acted quickly to get advice and support from other healthcare professionals when needed. One told us, “[Family member’s] medicines and seeing the GP all work okay. Staff will inform us if the district nurses are involved, it’s usually if [family member] has any sores, and they change their position every 2 hours. Whenever this has happened staff have acted on it straight away.” A healthcare professional told us, “The care home actively has good practice and actively promote any information that we provide.” People’s health outcomes were promoted as staff took timely action to escalate any concerns appropriately.

Care plans included how people could be supported to maintain their health and staff knew and understood what actions to take to ensure their care led to improvements in their health. For example, care plans included if people needed any pressure-relieving equipment and staff were knowledgeable on how to promote healthy skin. One staff member told us, “One person was always having redness under their legs. We informed the nurse and we now reposition them every 2 hours. The tissue viability nurses and our own nurses have shown us how to position them properly and elevate their legs as in their care plan and use a pillow between their legs and their skin is now healing.”

Langdale Heights had received a ‘Certificate of Participation’ for taking part in a local falls support initiative aimed at improving care and the management of falls. Leaders analysed falls in the home each month. The most recent falls audit had identified no-one had experienced a repeated fall and there had been no injuries sustained from falls. The audit reviewed the clinical response taken to falls and found that immediate first aid and post-fall observations along with neurological observations had been taken. Care plans and incident forms we reviewed confirmed this and detailed the falls prevention measures in place. For example, the use of a low-profile bed and support from staff when mobilising. This meant actions were taken to help prevent falls and when falls had occurred actions were taken to monitor people’s health and improve a person’s health.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

People were supported to experience improved health as the staff team monitored people’s health well and took actions to help prevent deterioration. A healthcare professional told us, “[Langdale Heights] is definitely one of the most organised homes, caring for the residents, able to recognise changes and deterioration. They will ask for any advice and whether [other healthcare teams] need to be involved.” They added, “The staff work well together under the supervision of [the nurse]. All changes or deterioration are communicated to us.They are proactive with all wound care and wounds tend to heal well with care and diet.”

Staff we spoke with had excellent and detailed knowledge of people as individuals and were able to describe what they would notice to indicate a change in people’s health. One staff member told us about a person who had acted in a way that had placed themselves and others at risk. They told us, “[Person] had their medicines reviewed after the incident. They like to be engaged in activities, and they like to work their brain.” They described some of the activities they provided for this person and added, “They have now settled.” The incident report for this person showed the involvement of a specialist dementia team to help provide advice and guidance. This showed a variety of actions had been taken to help improve the person’s well-being.

Clinical supervisions had been used to inform and support staff to effectively monitor and improve various areas of care. For example, clinical supervisions were held on how to accurately complete wound care plans and the use of ‘aseptic non-touch techniques.’ This is a standard way of working to help prevent infections. These supervisions helped to ensure staff worked to provide a high quality of care when monitoring people’s healthcare needs.

Care plans were detailed in how staff could take early proactive actions to help promote people’s well-being. For example, one person’s care plan described how a person expressed their anxiety and detailed effective strategies to use to help the person feel reassured and calm. These included topics of conversation that helped and what activities could be introduced to help redirect the person to help them gain reassurance and feel better. These details in people’s care plans helped staff effectively monitor people and to be able to take early action to help improve their health.

Where people had care plans and risk assessments in place for managing hypertension, which can significantly increase the risks of a stroke, information was provided on how to identify the first signs of this deterioration. This included using the recognised FAST acronym (Face drooping, Arm weakness, Speech difficulties, and Time to call emergency services), that helped guide staff to recognise and act quickly on the most common signs of a stroke.

Care plans clearly identified when staff were to take action in relation to weight loss. For example, care plans identified the ideal weight a person needed to maintain for their health, and what weight would trigger a referral to the dietician to assess for fortification of food and any other actions to help promote the person’s health.

Leaders maintained an overview of the monitoring in place for people’s healthcare needs to ensure it was effective. Regular audits checked monitoring was in place and completed to the expected standards and showed care was effective at improving people’s outcomes. For example, the recent audit found the condition of all wounds were improved or remained the same with no wounds showing any deterioration. It effectively identified which people had not met their daily fluid targets and identified daily monitoring and further spot checks to ensure this was improved.

Other monitoring charts were routinely checked to ensure people’s healthcare needs were being effectively monitored and actions taken to improve their health outcomes when needed. These included checks on food intake and when people needed to be repositioned to help prevent pressure sores. Additionally, leaders had a system in place to track and monitor progress of any tissue viability concerns and to review the preventative measures in place to aid healing. This oversight helped to ensure effective monitoring and promotion of health outcomes for people.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We observed staff engaged with people well and asked for their consent for their care during our inspection. For example, people were asked if they wanted to use a clothing protector when they were eating their meal. Relatives agreed. One relative said, “Staff always tell [family member] beforehand what they will be doing.” Staff we spoke with understood the importance of seeking people’s consent and how best to do this. For example, one staff member told us, “We always explain what we are going to do. We always ask and we always document it.”

Information on how people could access advocacy services was available and we saw people received support from advocates when appropriate. Advocates are independent professionals who support people in expressing their views, understand their rights and make decisions. Ensuring advocates were involved in people’s care decisions when appropriate, helped to ensure people’s rights around consent to care and treatment were upheld.