Langdale Heights

On this page

• 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

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People were consistently placed at the centre of their care. Care plans and risk assessments for people’s care needs were shaped by their individual and unique experiences. For example, one person’s care plans and risk assessments were developed based on their lived experiences as a person with a learning disability. For other people, their care plans and risk assessments started from their unique experience of living with dementia and how this affected them. This meant that the management of any risks, such as from falls, continence needs, medicines or epilepsy were all approached from the unique perspective of the person, whether that was living with dementia or having a learning disability. Where people had been unable to provide consistent or detailed information due to, for example, living with dementia, staff had considered additional input from their known life history and ongoing care observations, and contributions from other people that knew them well. This helped staff continue to develop person-centred information so as to develop and provide care with empathy and a detailed understanding of each person’s unique perspective.

Records continued to demonstrate staff provided person centred care. For example, when a person did not want their breakfast, this was offered later with success. Other measures of successful person-centred care were demonstrated when staff recorded incidents on Antecedent, Behaviour and Consequence (ABC) charts. ABC charts are a behavioural observation tool used to identify the cause of a behaviour, and to find patterns and to develop further understanding of a person. Records for one person showed staff had successfully followed their care plan and the person had shown they had calmed in all episodes and did not require any additional use of medicine to help a good level of well-being return.

Staff consistently demonstrated excellent knowledge of people as individuals. One staff member told us, “We look at what people like. [One person] likes to sing with staff; [another person] likes to walk around, [this person] likes to watch TV in bed with a cup of tea, they love all aspects of dressing and having lots of dressing choices.” Another staff member told us, “We will ask and provide people with choices, even though we know they always like tea and [name of person] will always say no to sugar.” Whilst another staff member told us how a person liked to eat their meal in a particular way. Staff told us they would discuss people’s history and life stories in their daily meetings, and this enabled them to interact with people in a more meaningful way. Staff understood what people enjoyed and always gave them choices and control.

During our inspection we observed multiple occasions when staff demonstrated excellent knowledge of people and provided person-centred care. Staff consistently talked with people and interacted with them over what they were doing. We observed staff respond to people when they began to show signs of anxiety. Staff responded in reassuring ways that helped the person settle and this reduced further risks from increasing upset and agitation. We observed other examples of person-centred care. One person had their breakfast served at a later time to suit their wishes and staff knew and understood the different activities people responded well to. These interactions all demonstrated staff knew people well and consistently provided person-centred care.

Relatives shared the view that their family members received person-centred care. One told us their family member’s personal care had improved as they had shared details of how staff could tell if they needed the bathroom. They told us, “Things are much better now.” Recent feedback from a visiting healthcare professional stated, ‘Observed really good person-centred care, which was compassionate, kind and caring.’

Leaders completed audits on care plans to check they were person-specific and that reviews were held with relatives every 6 months. Ensuring on-going regular engagement with relatives helped to continue to develop person-centred care planning. This ensured person‑centred care was continuously reviewed, strengthened and embedded across the service.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Leaders worked to ensure people continued to receive the care they needed, even when this was provided in a different setting and by a different service. For example, if people needed care in hospital, staff would accompany people if relatives were unavailable. Staff understood this was important as they knew people’s needs and knew a hospital admission would be a disorientating experience if a person was living with dementia. This demonstrated the provider understood the needs of the people they cared for, and they responded with flexibility to ensure continuity of care when circumstances required this to change.

People’s care plans identified when staff were to refer for further support from other healthcare services. For example, if people reached an identified weight, they would be referred to dieticians. This helped to ensure people received access to community-based services when needed.

Records showed people received support from a variety of professionals, including staff from specialist dementia teams, dieticians, speech and language therapists, physiotherapists and advocates to ensure people’s rights were upheld. This meant people’s care was joined-up, flexible and supported choice and continuity.

Leaders helped people and relatives understand the different types of funding available to help pay for people’s care. They provided an overview of information in an introductory brochure to Langdale Heights and were available to help discuss this further with people and relatives. This helped to ensure people receive support and were helped to understand the funding involved in care to help support people’s choices and promote continuity of care for them.

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

People’s communication needs were assessed and understood through any health conditions that people had. For example, if the person was living with dementia, assessments identified how people processed information and where they had any difficulties. For example, whether people could understand complex information, needed information provided in simple language, required additional time to process information or whether their understanding was affected by poor short-term memory. This helped information to be delivered in ways that maximised the chances of the person understanding it.

Care plans detailed how people felt if they were unable to understand information and what this looked like, so as to help guide staff whether their communication was successful. For example, when one person did not understand information, they would become frustrated, repeat themselves and misinterpret situations. When people needed any aids, such as glasses and hearing aids, assessments clearly identified the need for these. Assessments identified the best environmental conditions needed for successful communication. For example, reducing background noise such as from a TV and other voices. This enabled staff to evaluate the effectiveness of their communication methods and change strategy if needed.

Assessments clearly identified when people were unable to understand information relating to their safety. For example, when they were unable to understand how to use the nurse call bell system to request staff assistance. Where this had been identified, staff took other action to ensure the person’s well-being, for example, staff were given guidance to make regular observations and proactive engagement and were not to rely on the person to request assistance and must remain attentive to both verbal and non-verbal indicators of need.

Additional ‘accessible information standard’ (AIS) risk assessments were in place when people had complex communication needs. The AIS is a requirement to help ensure people with communication needs receive communication support and information that is accessible. This identified when a person needed information to be delivered verbally, with visual prompts and whether physical touch such as hand holding and use of reassuring tone and gestures aided communication further. The AIS policy was on display in the main reception area to help promote awareness of how information could be provided in different ways for people.

Leaders told us, they assessed people’s communication support with them and used communication passports, sensory profiles and personalised interaction plans to support communication with people. This helped to ensure a holistic view of people’s communication needs.

We observed visual menu planners were used to help prompt people with their meal choices and staff told us of the variety of communication methods that were available to support people. For example, staff told us they would make sure people had their hearing aids with them and would report if they experienced any problems with them. They went on to explain, “We communicate with people verbally and have pictorial prompts. We have ‘Yes’ and ‘No’ cards and ‘Thumbs up’ and Thumbs down’ cards. It all depends on if people want to use them or not.” Records recorded where people had responded with a ‘thumbs up’ when communicating. For example, when providing feedback to questions about their experience of care at Langdale Heights. This demonstrated people were supported to use different communication methods to participate and share their views.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

Leaders demonstrated and excellent culture of listening to people. They used a variety of methods to continually gather and listen to feedback about people’s experiences of Langdale Heights. Regular reviews of people’s care plans were held with them and their relatives or advocates. Advocates are independent professionals who support people in expressing their views, understand their rights and make decisions. These were structured and ensured conversations covered all aspects of people’s care, activities, personalisation of their bedrooms as well as inviting people and their relatives to suggest anything that could be done differently. They presented opportunities for meaningful engagement and helped to ensure people continued to receive person-centred care.

Regular meetings were held between staff members and with each person individually, or with another person they were close to. Records showed these conversations covered how people experienced living at Langdale Heights, what they thought of the food and activities, their relationships with staff and discussions on what, if anything, people would like changed. The comments made showed people were happy with their care and support and appreciated a personalised and responsive service. For example, one person who used digital equipment gave feedback that staff always made sure the equipment was charged up and ready to use. This helped to ensure people had chances to give feedback on their care and experiences.

We reviewed how leaders had resolved the most recent informal concerns that had been raised with them. These showed when anyone raised a concern, leaders had listened to them to fully understand their view and experience. As such, what the complainant wanted to be achieved from raising the concern was understood by leaders from the start. Leaders provided reassurance that their concern would be thoroughly investigated. Records showed leaders had taken immediate actions in response to any concern being shared with them. These actions were robust, clearly documented and showed the thorough investigations completed and findings completed. They showed concerns were resolved quickly. Actions included sharing the concern and findings with the staff teams so they were aware of anything they needed to be done differently, any improvements that could be made, or any continuing good practice that needed to continue. Leaders kept complainants informed of the findings and the actions they had taken in response.

Leaders audited any concerns, complaints and lessons learnt each month. This helped them to identify if any issues raised had been upheld and they checked to ensure there was an open and accessible feedback culture with informal concerns addressed quickly.

Relatives had completed a feedback survey that asked for feedback on aspects of the quality and safety of services provided at Langdale Heights. The completed feedback surveys all showed people were very satisfied and had made positive comments. Visiting health and social care professionals had been invited to provide their feedback on whether they were satisfied that people’s health and care needs were met, that they received the information they needed and had been able to fulfil the purpose of their visit. Again, these had all been completed with very positive feedback and comments.

Leaders ensured feedback had been captured and listened to. As well as feedback from people’s surveys, they had used regular feedback from relatives to continually inform their analysis of people’s and relatives’ views on the service. As a result of people’s feedback, positive changes were made for people. For example, one person had their preferred healthy snacks, and this helped to improve their health.

Information on how people could complain, make a suggestion and give a compliment was displayed in the main reception area. Relatives we spoke with all shared the view they could give feedback and comments, and although they had no complaints to raise, they told us they would feel able to complain if this was needed.

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

Relatives told us people accessed the care and support they needed without delay. Relatives told us of how staff had accompanied their family members to hospital when needed so they were able to access emergency healthcare without any delay. People were supported to access community services. For example, from opticians as well as from audiologists and dieticians.

Protocols were in place to manage emergencies. For example, staff had access to leaders at any time, including out of hours and over the weekend. Business contingency planning was robust and ensured plans were in place to help ensure people continued to be able to access the services they needed should there be an emergency.

People’s care plans fully demonstrated the reasonable adjustments needed to ensure people could remain active in their everyday lives and access the services and activities they needed. For example, for people living with dementia, this informed how people best understood information and what activities were most suited to their memory, cognition and ability. Whilst people’s care plans and risk assessments were digital, records showed people and their relatives had the opportunity to regularly discuss these. One relative we spoke with confirmed they had been sent these in a paper format for them to read. This meant people and relatives were provided with information in ways they preferred and ensured their care plans and risks assessments were accessible to them.

The care home environment had been adapted to be an accessible home, with a lift between floors and equipment in place such as wheelchairs and hoists for when people needed these to help them transfer. This helped to ensure the home environment was accessible and suitable for people.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Care plans consistently reflected a strong understanding of people’s health inequalities and detailed what steps could be taken to help these be reduced so people could experience equality in accessing the services they needed. For example, when people were living with dementia, information was provided on how to reduce background noise and distractions when discussing their choices with them to ensure they had the best possible chance of understanding the information and making choices. For another person, their care plan fully supported the person to participate in activities by clearly identifying how to reduce the chances of them becoming anxious or upset and this helped them to maintain meaningful relationships and engagement in activities to promote their well-being. This helped to promote equality of opportunity for people living with dementia.

Additionally, people were invited to share important personal information as part of their care plan assessment process and had been asked if they consented to have this information shared with others. This included details of people’s sexuality, their gender, ethnicity and religion. This was held securely in their care plan to help inform people’s care. This information helped to inform assessments and ensure people were supported with any equality needs.

Equality and diversity had been actively embedded into staff practice. All staff had completed training in equality and diversity to help them understand the challenges people faced from discrimination. Staff discussed people’s care with them, and their relatives face to face to help ensure their voices were heard. Face to face communication was used for when their care plans were being reviewed, as well as when their views and opinions were being asked for. Staff held discussions with people individually to again, help improve their understanding and maximise their chances of involvement. This meant staff took action to ensure people whose voices may not always be heard were listened to.

Leaders supported equity through accessible information and transparency. People’s expectations for living and receiving care at Langdale Heights were set out clearly in the ‘service user guide’ provided to people. This covered the process of moving into the home, an introduction to the staff, the care services provided, the facilities and equipment available. It set out the visiting professionals people would have access to, such as dentists, chiropodists and opticians and how support to external appointments were arranged. The guide contained a ‘Charter of service user rights,’ including the right to privacy, dignity, independence, fulfilment, security, respect and equality. Additionally, people were provided with information on how to access important services, for example, safeguarding, as well as how to make a complaint, and how to access important policies and procedures such as health and safety and equality and diversity policy.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

Staff were well trained and confident in providing end-of-life care. Nursing staff had received clinical supervision in the pain management techniques to support people to receive comfort and dignity when on end-of-life care. There was a clear policy in place to support the use of the equipment and clinical interventions, ensuring care was delivered safely and consistently. One staff member told us, “We make people dignified and comfortable. Their days should be happy, they should be well dressed, given fluids and mouth care and have their music on. Families will attend; we want to give dignity and respect.” A designated staff member held a lead role as a ‘Champion’ for good quality end-of-life care, to ensure they were embedding best practice across the service. Information on what good quality end-of-life care looked like was available to people and relatives in the main reception area along with details of the staff member’s ‘Champion’ role in this area. This included, promoting best practice, supporting staff to recognise and respond to people’s changing needs, ensuring that people’s wishes and advance care plans are followed, coordinating with families and professionals for seamless care, providing training and offering support throughout the person’s care pathway. Additionally, staff working in this area had been recognised as a finalist in the Caring UK Awards 2025. This helped to demonstrate and recognise the good practice that was being implemented and followed at Langdale Heights.

Care plans included details to help ensure care would be provided in line with people’s expressed views and recorded decisions. For example, one person wanted to remain at the home for care wherever possible in their familiar surroundings to help support their emotional wellbeing and reduce their distress. One relative we spoke with confirmed they had been given the opportunity to discuss their family member’s end-of-life care with staff and that this had helped to inform the person’s care plan. This helped to demonstrate people had contributed to the development of their care plans and as such their views and wishes were known and respected.

Whilst people’s care remained focussed on monitoring and promoting their health and stability and responding appropriately to any signs of deterioration, detailed plans were in place ready to support a person should end-of-life care be needed. These included for example, how to monitor for pain and how to provide mouthcare. This proactive approach helped to prevent unnecessary distress and ensure people would receive responsive, compassionate care when needed.

Care plans showed how people were supported in line with any advance decisions they had been involved in, such as those made in their ‘Recommended Summary for Emergency Care and Treatment’ (ReSPECT) forms and ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) decisions. ReSPECT forms are a personalised document containing recommendations for a person’s clinical care in a future emergency in which they are not able to make decisions or express their wishes. They include whether, along with DNACPR forms, in the event such as if a person’s heart stops or they stop breathing, they would want Cardiopulmonary Resuscitation (CPR) to be completed or not. Having people’s wishes clearly known for their future care helped to ensure their rights would be upheld. Policies were in place to ensure staff had clear protocols in place on the use of CPR and included how to share these important documents if a person transferred their care to another setting.

Medicines to help ensure people remained comfortable and would receive appropriate pain relief, should they commence on end-of-life care, were held in stock for people where it was anticipated people may need them at some future point. Having these needs anticipated and the relevant medicines available meant there would be no delay in ensuring a person’s comfort should their health deteriorate. This helped support staff to be able to provide responsive care. Leaders made regular checks to ensure care planning for end-of-life care was in place and to the standard expected. For example, a recent audit checked to ensure all people had advance care plans in place along with the relevant ReSPECT and DNACPR forms, if appropriate. They checked to ensure people’s preference for their preferred place of care and any anticipatory medicines were in stock where clinically appropriate. This additional scrutiny helped to ensure care was provided to the standards expected.

Visits by Directors had recently checked on the standards of end-of-life care. They found it to be in line with their expectations for compassionate care and in line with best practice. They found some care plans required further person-centred details to be added to ensure all people’s preferences and emotional and spiritual needs were discussed and recorded. The action plan created following the Directors’ visit confirmed these actions had been taken. This helped to demonstrate that leaders looked to ensure end-of-life care was well managed and met their expectations.