Langdales

Langdales is a residential care home providing personal care to up to 25 people. The service provides support to older people who may be living with dementia. Accommodation is set over two floors with a lift to the first floor, At the time of our inspection there were 17 people using the service.

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

People told us they felt safe and they were supported by staff who helped them quickly if they needed this. Checks were completed to help ensure prospective staff were suitable to work with vulnerable people. Risk assessments were carried out to help minimise the risk of avoidable harm and staff knew the help and support people needed. Medicines were managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Audits and checks were in place to help drive improvement and identify success. However, these had not been fully implemented at the time of the inspection. The manager had started to implement and document the audits carried out and was supported by the management team to do this. Staff told us morale was high and the service had improved. They were confident the improvements would continue and spoke about how good teamwork would help them achieve this. People told us they could speak with the manager and the home was well organised.

Rating at last inspection and update: The last rating for this service was requires improvement (14 February 2022) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 February 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langdales on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Langdales is registered to provide care for up to 25 older people or people living with dementia. It is a detached home in central Blackpool. Bedrooms are of single occupancy. There are communal lounge and dining areas. There is a garden area at the rear of the home, with a visiting pod. At the time of our inspection 14 people lived at Langdales.

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

Medicines had not been managed safely and properly. Risk to people’s health and wellbeing had been managed inconsistently. The provider had not used incidents as an opportunity to learn and improve the service.

We found shortfalls in governance and leadership of the service. The provider’s systems to assess, monitor and improve the service had not been operated effectively. Records relating to people’s care and the management of the service were, in some cases, of poor quality or unavailable for inspection.

People told us they felt safe and described staff in positive terms. One person told us they felt, “Well looked after” and described staff as, “Very caring.” Staff knew how to protect people from the risk of abuse and staff had been recruited safely.

The provider has been receptive to feedback from CQC and other agencies. They have taken swift action to resolve issues and make improvements to the service which now need to be sustained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 June 2019).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to risk management and the quality of people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider took immediate action to address the shortfalls found during this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langdales on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to leadership, quality assurance and records at this inspection.

Please see the action we have told the provider to take at the end of this report.

We made a recommendation about duty of candour.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Langdales is registered to provide care for up to 25 older people or people living with dementia. It is a detached home in central Blackpool. Bedrooms are situated on all floors. There is a communal lounge and seating areas. There is a garden area at the rear of the home, with a visiting pod. There is a pay and display car park next to the home. At the time of our inspection 23 people lived at Langdales.

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

People were safe and cared for. Staff demonstrated a good understanding about safeguarding people from the risk of abuse. They knew what action to take if they suspected people were being harmed. Staff interacted with people in a friendly, cheerful and respectful way. There were enough staff to meet people’s care and support needs and to chat with and involve people in various activities. There was a robust recruitment system to reduce risks of employing unsuitable people. Staff supported people with their medicines according to national guidelines. They assessed and helped people manage avoidable risks.

The home was clean and hygienic. This reduced the risk of infection outbreaks. The infection prevention and control policy was up to date. Staff followed infection control guidance and encouraged people to do the same. The building was maintained, and equipment serviced as required. The registered manager monitored infection control practices to make sure they were safe.

The registered manager and senior management team monitored the service to make sure staff were providing safe care. They understood and acted on legal obligations, including conditions of CQC registration and those of other organisations. They worked in partnership with other services and organisations to keep people safe and improve their well-being.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 06 June 2019).

Why we inspected

We received concerns in relation to the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report. The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langdales on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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.

Langdales is a care home for up to 26 older people or people living with dementia. Accommodation was arranged around the ground and first floor with office accommodation on the second floor. Each person had their own bedroom and shared the lounges, dining room and other facilities. There was a small garden area to the rear of the building. There was a passenger lift for ease of access and the home was wheelchair accessible. At the time of the inspection 17 people lived at the home.

People’s experience of using this service:

People told us the registered manager and staff were kind, friendly and caring and they felt safe at Langdales. There had been a change of registered manager since we last inspected. People were positive about the way she ran the home and the changes she had made.

People were supported by staff who had been recruited safely, appropriately trained and supported. Staffing levels were sufficient and staff appropriately provided safe care. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff involved people in planning their care and encouraged them to make choices. They supported people to manage risks and stay safe and to remain as independent as possible. People were supported to air any concerns they had and the registered manager took action on these.

People were helped to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff assessed people's capacity to make decisions and supported them with making decisions. making. People were encouraged to air their ideas, views or concerns. Staff were guided in how to manage complaints.

Staff supported people to eat healthy nutritious food and drink sufficient fluids and knew their likes and needs. Staff helped them to attend healthcare appointments to assist their health and wellbeing. They understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. Their end of life wishes were recorded so staff were fully aware of these.

The home was clean and maintained and staff practised good infection control. Water temperatures were at a safe temperature and equipment had been maintained. People had been able to personalise their rooms with their own furniture and personal effects.

Staff worked in partnership with other organisations to make sure they followed good practice and

people in their care were safe. The management team used a variety of methods to check the quality of the service and develop good practice.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 31 May 2018).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if any issues or concerns are identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This is the first inspection for Langdales since a change of ownership. Diamond Care Homes Langdales Ltd took over the home from another registered provider and became the registered provider with the Care Quality Commission (CQC) on 18 July 2017.

Langdales is a care home that provides accommodation to up to 26 people who require personal care and support. Some of whom are living with dementia. Accommodation was arranged around the ground and first floor with office accommodation on the second floor. There was a small garden area to the rear of the building. There was a passenger lift for ease of access and the home was wheelchair accessible.

At the time of the inspection 17 people lived at the home.

There was a registered manager in place. 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.

People we spoke with told us they felt safe and cared for at Langdales. They told us they were satisfied with the care they received and were supported by staff who treated them well. One person told us, “I feel safe here. The girls make sure of that.” Another person said, “I love it here. I feel better and safer here than I did at home.” However, although we saw good practice we also saw areas of care that reduced people’s safety.

Medicines were not managed safely. Medicines were not always stored correctly, or administered according to the home’s procedure or good practice. This put people at risk of not receiving their medicines.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safe care and treatment) as the registered provider had failed to ensure the proper and safe management of medicines;

Staff did not always take the need for confidentiality of people’s information into account. We saw on one occasion people were asked personal questions in a communal area. No other people were present in this area but there was the possibility of being overheard. Also on day one medicines records and other charts were not always stored securely so could possibly be accessed by people other than those who should see them.

We have made a recommendation about ensuring confidentiality of information.

Although care plans were personalised, they did not have all relevant information about each person’s care in them. This reduced the knowledge of staff who were unfamiliar with the individual.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the registered provider had failed to ensure records maintained were accurate and reflected people’s needs.

The service had not discussed with people and documented their preferred end of life wishes.

We have made a recommendation about this.

We saw there had been recent changes of area manager for the organisation, and the way audits to assess and monitor the service were completed. The recent audits to assess and monitor the quality of the service had shown where gaps and omissions were. Actions in response to the audits had started but were still on-going when we inspected.

We have made a recommendation about continuing auditing the service and completing any actions highlighted promptly.

We looked around the building and found it had been maintained, was clean and hygienic. The design of the building and facilities provided were appropriate for the care and support provided. However when we checked a sample of water temperatures, we found the water was very hot in two rooms. The registered manager took immediate action, checked all water outlets to ensure they were safe and contacted a plumber to arrange further checks. Equipment had been serviced and maintained as required.

People told us staff were kind and caring and this reflected our observations of how staff interacted with people. We saw staff spoke with people in a respectful way and were sensitive and caring when supporting people. We saw staff provided personalised care that helped maintain people’s well-being. They usually responded promptly when people needed assistance. However one person spilt their drink on themselves and although interaction was positive and frequent staff did not notice the spillage. We saw people had access to healthcare professionals and their healthcare needs were usually met promptly. Staff provided care in a way that respected peoples’ uniqueness, dignity, privacy and independence.

There were sufficient levels of staff to support people with personal care and social and leisure activities during the inspection. However one person who did not eat their lunch may have done so with staff support. Several staff and people who lived in the home felt additional staff at busy times would be helpful.

People said they enjoyed some leisure activities in the home but the frequency and variety of these fluctuated. The registered manager had advertised for an activity coordinator to develop and lead on social and leisure activities.

There were procedures in place to protect people from abuse and unsafe care. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. We saw risk assessments were in place which provided guidance for staff in how to safely support people. This minimised potential risks.

Staff recruitment was safe. Staff said they were supported to develop their skills and knowledge to assist them to carry out their role. They had skills, knowledge and experience required to support people. Most of the staff team had remained in the home's employment during the change of provider. This meant they had knowledge of the home and people who lived there and people were cared for by staff who were familiar to them.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were offered a choice of nutritious meals. Staff knew people’s nutritional needs, likes and dislikes. People said the food was varied and were offered drinks, fruit and other snacks outside of meal times.

There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of infection.

The service had a complaints procedure which was made available to people who lived at Langdales and their representatives. There had been no complaints made to the home in the previous twelve months. The service had information with regards to support from an external advocate should this be required by them.

You can see what action we have asked the registered provider to take at the back of the full version of the report.

The inspection was prompted in part by notification of an incident, when the location was owned by a different provider, following which a service user died. This incident is subject to a separate investigation and as a result this inspection did not examine the circumstances of the death. However the information shared with CQC about the incident indicated potential concerns about the management of health issues. This inspection examined those risks.

Since the incident the ownership of Langdales changed hands in April 2017. The registered provider is now Diamond Care Homes Langdales Ltd. We carried out this focused inspection to ensure the new provider was managing people’s health issues. This report only covers our findings in relation to the potential concerns. As they have not yet had a comprehensive inspection as this new organisation, they have not been formally rated.

We spoke with four people who told us they felt safe and ‘well looked after’ by the staff team.

We looked at care and support of people who needed assistance with personal care. We checked care records of people who were at risk of skin breakdown and pressure sores. We saw care plans, risk assessments and daily reports indicated checks had taken place. Repositioning charts to record the person’s positional changes were used where needed.

Pressure aids were in place where people were at risk of developing pressure sores. Action was taken and support and guidance sought where people were at risk of tissue damage.

We looked at how staff received information and guidance. We saw staff received supervision and staff meetings took place with records kept. Any care issues or changes were highlighted to staff in both individual supervision and staff meetings. Staff training in the care of people at risk of pressure sores had been sourced and arranged so staff had up to date knowledge of current care and guidance.

Audits were frequent, documented and any issues found on audits acted upon promptly. Audits were forwarded to the directors of the organisation who checked actions were taken where needed.