Langdale Heights

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding. This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 94 (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 had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Leaders had developed and embedded an exceptional learning culture and were consistent in applying this to actual or potential safety events. This approach had been consistently successful in identifying the root cause of events and the actions to take to successfully reduce and manage any potential ongoing risks. Leaders ensured any learning from incidents had been embedded into ongoing practice. Any changes or updates had been consistently shared with the staff team and updated in people’s care plans and risk assessments. For example, a review of an incident identified the need for earlier one-to-one therapeutic engagement for a person to help prevent their anxiety increasing. We saw this had been introduced and had been successful. Another incident review showed, where a person receiving anticoagulation therapy had an increased risk from bruising, additional monitoring had been put in place following any injury or fall. This meant reviews of incidents led to improved safety for people.

Healthcare professionals working with the home supported the view that Langdale Heights had a strong and proactive learning culture. One of them told us, “Langdale Heights have a really good learning culture and take any training needed. They will ask for advice regarding safety concerns and work well with ourselves.” The actions taken at Langdale Heights to learn from events and incidents helped to keep people safe and promote a culture of safety.

Successful team working and excellent staff knowledge supported a proactive learning culture. Care staff and nurses were consistent in reporting incidents. One member of staff told us, “Nothing is hidden, it is very transparent. Communication is key, we can report anything as it is good for the risk assessments.” Records showed staff had provided very thorough accounts of any incidents or accidents. This excellent level of detail and consistent reporting enabled robust learning and improvements to be successfully identified.

Leaders worked as a team to ensure reviews of potential safety incidents were consistently robust. Leaders completed audits of incidents and identified any repeating patterns and causes. This involved reviews by other staff in the provider group with a compliance and quality role and leaders shared lessons learnt with other care homes within the provider group. This helped to ensure additional scrutiny of the initial investigation and actions taken. It contributed to the successful identification of all relevant actions to be taken to learn lessons and checked all relevant learning had been implemented. This helped to ensure a consistent and valuable lessons learnt culture had been embedded.

Safety incidents were assessed against the requirements to notify the Care Quality Commission (CQC), refer to the local authority, report under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) and to inform relatives. Relatives we spoke with told us staff always informed them of any changes regarding their family members. One relative said, “The slightest mark on [my family member’s] skin and staff ring me straight away.” This ensured the provider had systems in place to consistently meet their duty of candour to be open, honest and transparent with people and their relatives regarding the provision of care.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

When people moved to Langdale Heights transitions were planned in a highly personalised way and relatives consistently told us they found the transition to have been successful and well managed. One relative said, “[Name of staff member] came out to assess [our family member] and we were drawn to them straight away.” Another relative said, “There was a good discharge, and the home were confident they could meet [family member’s] full care needs. They are now hoisting [family member], so this is another change, but they have been able to adapt and meet their new needs.”

The service was highly regarded by visiting healthcare professionals who worked with the service. Professionals consistently described the home as proactive. One visiting healthcare professional told us, “Langdale Heights are very organised, they are proactive rather than reactive. The nurses do what is expected and will seek support. They are very good at planning care and do their own referrals. The ward round is short because they are so organised, all acute conditions are sorted.” Recent feedback from another visiting health professional stated, “The nursing home cares for people brilliantly and ward rounds each week provide detailed information regarding people. People are very well looked after, excellent care.” All these actions helped to ensure people consistently received safe care even when their care was shared between different services.

Leaders recognised hospital admissions and discharges as a particularly high‑risk transition point and had taken clear steps to strengthen practice in this area. Clinical supervision sessions had been held with nursing staff regarding the correct protocol and actions needed when a person returned from hospital. Staff told us they followed processes to ensure important information about a person’s care needs would be prepared and accompanied them to hospital, should a hospital admission be required. They said if relatives were not available to accompany people, then they would go with them so people would not be left on their own. Relatives we spoke with confirmed this. One relative said, “[Family member became unwell] and staff organised transport to the hospital. Staff took them and stayed with them, and when we went [family member] was settled.” Staff followed clear processes and had received support and supervision to ensure people received safe care when they needed to transition between services.

Robust processes were consistently followed to ensure all the important information about people’s care needs had been established in a timely manner. This included their care plans, risk assessments and any considerations needed under the Mental Capacity Act 2005 (MCA). Completion of this information was checked by staff holding roles in compliance and quality. New admissions were further checked as part of the provider’s regular quality assurance visits to Langdale Heights. This helped to ensure people experienced a positive and successful transition when they moved to live at Langdale Heights.

Leaders maintained strong, responsive referral pathways to external professionals. People’s care records showed referrals were made to other health care professionals to ensure people continued to receive the care they needed. For example, people were supported to access opticians, audiologists, dieticians and other services. Relatives confirmed this. One relative told us their family member had an issue with their dentures and said, “The home has helped [family member] get them fixed.” These actions demonstrated a commitment to ensuring transitions and shared care pathways actively supported people’s comfort, dignity and ongoing wellbeing.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider always shared concerns quickly and appropriately.

People’s safety when living at Langdale Heights was managed proactively and active steps were taken to ensure people were protected from the risk of abuse. People’s care plans identified where they may be vulnerable to potential abuse and provided clear, practical guidelines to staff on how to help safeguard people. Importantly, this included guidance to staff on acknowledging a person’s concerns respectfully, without challenge or dismissal and to report immediately. Recent incident reports showed even when an incident did not meet the threshold for a safeguarding referral, the social care professionals involved with the person’s care had been kept informed. This demonstrated a safeguarding approach focusing on early intervention and partnership working to ensure people’s rights were protected and people received any safeguarding protections needed.

Staff were confident and knowledgeable in how to identify and take appropriate action if they identified potential signs of abuse. This included staff knowledge on whistleblowing and how they could report concerns to outside organisations such as the Care Quality Commission (CQC) if they believed the right actions in response to concerns had not been taken. One staff member told us, “We protect individuals from neglect and if we have any concerns we report to our line manager. We need to give proper care and if we see bad practice we inform our senior managers.” Another staff member said, “If abuse happens, I can report it to our shift lead and the team leader. If nothing happens, we can speak to other managers, then to directors and we can go to CQC.” Staff knowledge on safeguarding people was regularly checked by the leadership team to ensure it was maintained to the high standards expected. This helped to develop staff to have a strong and confident knowledge of safeguarding and the action to take to keep people safe.

People consistently told us they felt safe living at Langdale Heights. One person told us, “I feel I could talk to staff if I was concerned about anything.” Whilst another person told us, “I feel safe now.” Relatives shared the view their loved ones received safe care. One relative told us, “We are so happy, it is absolutely safe care here. We can't honestly fault them.” Visiting healthcare professionals also expressed confidence in the service and had no concerns for people’s safety. One visiting healthcare professional told us, “Safety of the residents is taken seriously. Langdale Heights look after and care for them well.”

People’s rights were upheld under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Assessments of people’s mental capacity were robust and demonstrated the steps taken by staff to assist the person to understand, retain, weigh up options and communicate their decisions. Where a person required a decision to be made on their behalf, the involvement of relatives, friends and advocates were included. Decisions taken were the least restrictive and made in the person’s best interests.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Assessments clearly documented when a person required a Deprivation of Liberty Safeguard to be in place. Any relevant conditions associated with a person’s DoLS were known, included in their care plans and monitored. Governance systems tracked and monitored mental capacity assessments and DoLS to ensure they were compliant with the relevant legislation and met the provider’s documentation standards. These actions helped to ensure people’s rights were upheld when they needed decisions to be made in their best interests and where restrictions were used they were proportionate, supporting safety while maximising people’s freedom and right.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

We observed staff consistently involved people in their care and this successfully helped people participate and promoted their safety. For example, staff provided clear instructions, combined with good practices in moving and handling techniques to help people safely mobilise and transfer positions safely. We observed staff ensured people had well fitted footwear to help reduce their risk of a slip or fall. When staff assisted people with their meals and drinks, they did this in ways to help reduce the risk of aspiration. For example, people were assisted at their own pace, with no rushing and staff provided people with the right amount of food at a time so people were not overloaded to help reduce the risk from choking.

Staff responded exceptionally well to dynamic and unpredictable risk. We observed an incident where a person began to show signs of risks to themselves and others. Staff remained calm, stepped away and continued to engage with the person positively, resulting in the person laughing. The staff member was then able to continue to help the person get comfortably seated.

Staff showed detailed knowledge on how to reduce risks to people and took prompt action to prevent them. They spoke confidently about checking people’s skin for changes and reporting these so that further pressure relieving measures could be taken. This included, repositioning people more frequently, using skin creams or pressure relieving equipment. We observed staff ensured people had their pressure relieving cushions with them when they helped people transfer to different seating areas.

Care plans clearly supported positive risk-taking and reiterated how to maximise people’s engagement with their care. For example, when a person was known to sometimes decline aspects of their care, their care plans detailed the factors that contributed to this and actions staff could take to maximise their participation. For example, to ensure the care environment was free of interruptions or overstimulation and that the person’s care was offered at familiar times within a structured routine to promote predictability which reduced their anxiety. The delivery of care for this person was planned to be delivered in a step-by-step approach which aimed to involve the person as much as possible. This approach to planning and providing care helped to ensure the person maintained a sense of control and improved their engagement. Relatives told us regularity and familiarity with care provision helped their loved ones. One relative said, “They keep things familiar for [family member] and that helps them.” The provider demonstrated they worked to fully understand people and their point of reference and worked with them to ensure they received positive support to do the things that were important to them and kept them safe.

Governance systems provided scrutiny to help ensure risks were managed well. Audits checked on how risks associated with people’s health and care needs were managed. For example, audits were completed on diabetes management to ensure blood glucose monitoring and storage of medicines for diabetes were completed and stored in line with good practice. Audits checked pressure reliving equipment was in good condition, and falls audits checked to ensure prompt clinical responses were taken, and updates made to people’s care plans and risk assessments.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff had completed training in areas relevant to maintaining a safe environment. For example, in health and safety and fire awareness as well as how to safely store and use cleaning chemicals and, the management of sharps within a care environment. Our observations showed the care home environment had implemented measures to ensure a safe environment. For example, window restrictors prevented windows being opened too far, heavy items of furniture, such as wardrobes were securely fastened to walls to prevent them from tipping over. Cleaning chemicals and medicines were stored securely and areas of the home where risks were present, such as the laundry room and kitchen were locked securely.

Staff were confident in how to manage and reduce risks in the environment. One staff member told us, “We have training on how to make the environment safe. We always make sure there are no trip hazards, people have their hearing aids and walking aids with them, and we encourage them to use their walking aids. We have to supervise people’s movements, ensure proper lighting and make sure there are no wet floors.”

Staff understood how environmental factors impacted on people’s safety. They knew and understood people well enough to help them sit in areas of the home that helped them stay safe. For example, some people preferred to sit in quieter areas and others preferred to be where there was more activity. Relatives told us being in the right part of the home environment helped their loved ones stay safe. One relative told us, “[Family member] is now in the dining room, we visit before lunch and it is a quieter area with music on. [Family member] likes quiet and can become agitated if not, so they sit in the best place for their needs.”

People’s confidential private information was kept safe. Digital systems were used to hold and store people’s information on their care needs. Staff accessed this on secure handheld devices. This meant people’s confidential private information was kept secure and private.

The provider organised and maintained safety checks on all aspects of the premises, equipment and utilities. For example, documentation was in place to show safety checks were made on gas safety, portable electrical appliances, and water safety checks to ensure the risk of legionella disease was well managed. Risks from hot water were managed and equipment used to transfer people, such as hoists, slings and the passenger lift were all regularly serviced and checked. Staff told us they made checks on items such as slings as part of their day-to-day work. One staff member told us, “If we notice a sling is not in a good condition, we report it.”All of these actions helped to ensure people lived in a safe environment.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

Leaders at Langdale Heights had identified a set of ‘core values.’ Core values are guiding principles that shape the culture and behaviour of the organisation. These included, ‘Excellence Through Skilled, Confident Staff.’ The provider valued and invested in training and supervision for staff and staff were completely up to date with the provider’s training requirements. This helped shape recruitment, training and everyday practice. Staff spoke confidently about all aspects of people’s care and demonstrated excellent knowledge gained from completing the provider’s training. Staff told us they could request additional training at any time. New staff completed induction processes specifically tailored to their roles and records showed staff were supported to complete the Care Certificate. The Care Certificate aims to ensure care workers have the same introductory skills, knowledge and behaviours to provide compassionate, safe and high-quality care.

Visiting leaders completed checks on staff knowledge. Records showed leaders had spoken with staff on their visits and checked their understanding of important areas, such as safeguarding, people’s care needs, the Mental Capacity Act (MCA), dignity in care, personalised care planning the different food requirements people needed. This helped to maintain high standards of staff knowledge and competence.

Staff members were empowered to act as ‘Champions’ in different areas important to the quality and safety of people’s care. For example, as champions for dignity, safeguarding, continence, nutrition and end of life care. One staff member told us how Champions shared good practice for their area and how they ensured the area they championed had sufficient products available. This approach strengthened staff leadership at all levels and helped good practice to spread across the service.

Staff told us they received an appraisal of their work as well as regular supervision which were meaningful development tools rather than just routine oversight. Supervision was planned so that clinical standards and on-going development were maintained. For example, supervisions were held on when to make referrals to the speech and language team, how to identify sepsis, pressure ulcer prevention measures and dysphagia. Further clinical supervision was provided to nurses to share the expectations on how to complete and audit of medicines, how to set up syringe drivers and the accurate completion of wound care plans. Observational supervisions were also completed and these showed staff had received checks on their competency to administer medicines and on how they supported people at mealtimes. Leaders told us staff were empowered to share their knowledge and contribute to the protocols in place. For example, leaders told us staff had developed and shared a referral pathway protocol for nursing staff. Where leaders had found staff required any additional knowledge, targeted individual sessions, reflective supervisions and on-going competency development had been put in place. These actions had helped to create and maintain a skilled and competent workforce.

People and their relatives spoke highly of the staff team at Langdale Heights and felt staff were capable and understood their loved ones. One relative told us, “Staff know [family member] well. [Family member] doesn't like the hoist, but staff talk to them, they know what to do and what to look out for.”

Relatives felt there were enough staff and valued the regular team of staff that worked at Langdale Heights. One relative told us, “There is not a big turnover of staff and so [family member] gets to see similar people and I think that is good as they have dementia.” Another relative said, “There is always a staff member monitoring [family member]. If we are with [family member], when we leave, a member of staff is always looking for them.” Another relative valued the fact a named member of staff was a contact and acted as a ‘keyworker’. They said, “There is a keyworker, but I see 3 members of staff for updates usually as I go so often.”

Our observations showed staff were present in communal areas and were able to swiftly respond to help maintain people’s safety. For example, we saw staff were available to quickly help a person who wished to move elsewhere. Where people needed staff with them throughout the day to help ensure their safety, we saw this was maintained in a way that promoted their safety without infringing on their sense of privacy. This showed a person‑centred, rights‑based approach to staffing that balanced safety with dignity, choice and autonomy.

Leaders reviewed the numbers of staff needed when people’s needs changed. This helped to ensure there were enough staff to help provide them with safe care. Leaders completed checks to ensure people’s needs were safely met by the numbers of staff on shift. For example, records showed leaders had visited and completed an audit on the night shift. This found staff were all deployed correctly and people were safe, comfortable and had their health monitored. Leaders also audited call bell response times and found staff had been able to respond to people using their call bells within an acceptable timeframe. These actions helped to check that there were enough staff deployed to safely meet people’s needs.

Staff recruitment processes were followed to ensure all the required checks for when staff worked in care had been completed. This included obtaining references of previous work experiences, checking the reasons for any gaps in employment history, obtaining a Disclosure and Barring Service (DBS) check. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider used a ‘values based’ recruitment process. ‘Values based’ recruitment is an approach which aims to attract employees on the basis that their individual value and behaviours align with the values of working in health and social care. This process, along with the robust recruitment checks completed helped to ensure the provider recruited staff who were well suited to work in care.

The provider assessed and managed the risk of infection. They always quickly detected and controlled the risk of it spreading and always shared concerns with appropriate agencies promptly.

People were happy with how their home was kept clean. One person told us, “Staff are cleaning all the time.” We observed staff supported people to clean their hands before they had food and acted quickly to clean up any food when some had fallen to the floor. Staff had supplies of, and wore, personal protective equipment (PPE) for when they provided care or were serving meals.

People’s care plans included details of when they had been offered vaccinations for infectious diseases such as flu. Leaders had a system in place to track any infections and reviewed actions taken to ensure these had been taken promptly. For example, when people had a chest infection or had a urinary tract infection. This monitoring helped to ensure quick and appropriate actions were taken to help prevent and control the risks from infections.

All staff had completed training in infection prevention and control, COSHH (control of substances hazardous to health) and cleaning. In addition, they had all completed newly introduced training and supervision on waste management to help ensure they understood the duties and responsibilities for care homes to handle and manage waste disposal to the required standards.

Cleaning staff told us they had clear plans for what needed cleaning each day and had sufficient cleaning materials available. Records showed cleaning staff followed cleaning schedules that detailed the method of cleaning required along with what cleaning agent to use to help ensure all areas of the home were regularly cleaned to the expected standard. Specific daily check lists were in place for the laundry area to ensure such cleaning items as mop heads were washed daily. These records showed cleaning duties had been consistently completed.

Cleaning was discussed each day as part of the daily management oversight of the home. Daily checks were made on the safe storage of cleaning materials, as well as the waste bin collection areas to ensure they remained safe. Further checks were rolled out during our inspection to help ensure the different types of waste were disposed of correctly. This included disposals for sharps, clinical and sanitary waste.

The standards of cleaning in the home were checked on the provider’s regular quality assurance visits. In addition, regular audits were completed to ensure standards of cleanliness and measures to prevent and control infection were effective. These included audits on commodes and bedpans, mattress and mattress covers, pressure cushions and covers. Competency based audits were also completed on staff practice for hand hygiene and correct use of PPE. A monthly overview of the care home environment checked all furnishing and fittings as well as areas of tiling and grout were maintained to the standards required for effective prevention and control of infections. The provider’s analysis of these audits found, ‘good assurance that infection prevention and control systems are embedded, monitored and responsive with no evidence of unmanaged infection risk. The audits demonstrate a strong culture of compliance, supported by staff knowledge, routine monitoring and timely action.’ Langdale Heights were also a participant in a wider health and social care research study to help reduce infections. Robust and thorough measures were in place to ensure risks from infection were reduced and managed well.

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff always involved people in planning, including when changes happened.

Where people required medicines to be offered ‘as and when required’ there were clear and up to date guidelines in place to help staff provide consistent safe care. Where medicines were prescribed to help people manage any behaviours that could cause risks to themselves or others, clear guidance was in place for staff to follow to try and reduce risks to people without the need to use medicine in the first instance. This was also reflected in people’s care plans. For example, one person’s guidelines advised staff offer a cup of tea and a chat and play some songs as an initial attempt to reduce the person’s anxiety. If this was not effective staff were to try giving the person space whilst monitoring and to only support with medicine as a last resort. For another person, their records showed their ‘as and when required’ medicine had been given in line with their guidelines and in line with their care plan. Records showed the reason for administering these medicines along with whether they had been effective. This way of managing people’s medicines was in line with good practice recommendations that social and environmental interventions can reduce stress and the need for medicines that work by affecting people’s moods.

People felt their medicines were managed well. A relative told us, “[Family member] always gets their medicines at the right time and it makes all the difference.” Staff with responsibilities for administering medicines had completed relevant training and had their competency in medicines management and administration checked regularly. Healthcare professionals involved with the home were happy with how they managed medicines. One healthcare professional told us, “From a medication perspective they certainly ensure changes are made when advised to do so and that the monitoring requests are adhered to.” This helped to demonstrate people’s medicines were managed well even when changes happened.

Measures to ensure medicines were managed safely were in place. Medicines were stored securely and stored at the correct temperature. Staff administering medicines demonstrated an excellent knowledge of people’s needs and spent time with them before administering their medicines, so their care did not feel rushed.

Medicines administration charts clearly reflected the prescriber’s instructions, along with a running balance of medicines in stock for each person. They had been consistently completed showing people had been offered their medicines as prescribed with no gaps. Medicine charts for skin creams detailed the area of the body the cream was to be applied along with the amount of skin cream recommended for the most effective treatment. This helped ensure people’s treatments were effective.

Where people required medicines for their health but may not reliably understand what these were for, or may not reliably accept them, decisions had been made in line with the requirements of the Mental Capacity Act 2005 for people to receive these covertly when required. Care plans provided clear guidance to staff and upheld people’s rights to be offered these medicines openly in the first instance before considering any covert administration methods, along with the requirement for consultations with the person’s GP, pharmacist and family. This ensured people’s rights regarding their medicine decisions were upheld.

Where people were prescribed medicines to treat specific conditions, such as for hypertension, the medicines prescribed for this were embedded into the person’s care plan relevant to this condition. Reviews of medicines with pharmacists or GPs were recorded. This ensured medicine treatments were included in a holistic view of a person’s care and treatment. Where medicines created increased risks or side effects, there were specific risk assessments in place, for example, when medicines caused an increased risk of bruising or where skin creams were flammable. These contained guidance to staff on the actions to take to manage these risks. For example, actions to take to reduce skin injuries when assisting a person to move. These actions helped to ensure people received safe medicines care.

Systems were used effectively to ensure medicines administration was managed well. Specific training had been provided so staff understood how to use the provider’s digital medicines management system. Medicines systems ensured leaders were able to maintain a thorough oversight on the management and administration of medicines at Langdale Heights. These included an overview of whether all medicines had been administered as expected for that time of day, as well as regular audits and spot checks of medicines and staff practices. Investigation procedures were in place should any medicines error occur. These measures helped to ensure good practice protocols for medicines management were followed and embedded at Langdale Heights.