We carried out a review of the data available to us about Langholme on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Langholme, you can give feedback on this service.
Langholme provides accommodation with personal care for up to 40 people. There were 38 people using the service at the time of our inspection. The service is purpose built two storey building surrounded by large gardens.
People’s experience of using this service and what we found
At the previous inspection we found care plans did not always report on when people’s needs changed and information in care plans was not always up to date. At this inspection we found improvements had been made and care planning, reviews and staff understanding of people’s needs were current. Staff told us they had the information they needed to support people.
At the previous inspection we identified that care files were not held securely. People’s care plans were stored in their bedrooms in boxes on the wall. These boxes had locks which did not always work. At this inspection the provider had taken action to ensure all personal care records were secure and only accessible to designated staff.
Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Medicines were safely managed.
There were processes in place to prevent and control infection at the service, through regular COVID-19 testing, additional cleaning and safe visiting precautions.
There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the service.
Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training, and this ensured all staff received the training and updates needed to provide safe consistent care.
Staff were supported in their roles through a plan of supervision. Staff told us they felt supported by senior staff and the manager.
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.
The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.
The systems in place to monitor the quality of care within the service were effective. The registered manager promoted a positive person-centred culture and fully understood their responsibilities as a registered manager.
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 Requires Improvement. (Published 31 October 2019)
Why we inspected
We undertook this inspection to check previous breach of regulation had been met.
Langholme provides accommodation with personal care for up 39 people. There were 39 predominantly older people using the service at the time of our inspection.
People’s experience of using this service and what we found:
When people’s needs changed this was not always reflected in their care plan. Care plans were regularly reviewed; however, some information was disjointed, not always up to date and not easy for staff to find.
Risk assessments provided staff with guidance and direction. However, some care plans and assessments did not contain accurate guidance and direction for staff to take account of recent changes in some people’s needs.
We observed kind and caring interactions between staff and people. Some staff chatted with people as they moved around the service. Other staff only interacted with people during a required task.
Meal time experiences were varied between the two floors. Downstairs staff chatted with people during lunch, while music played. Upstairs, people in the dining room ate in silence, with staff gathered in the kitchen. Visual assistance was not provided to people to help them make a meal choice.
Care files were not held securely. People’s care plans were stored in their bedrooms in boxes on the wall. These boxes had locks which did not always work. Many care plans were not held securely. This was addressed at the inspection and they were moved to be stored elsewhere until the locks on the boxes could be repaired.
Audits were carried out regularly to monitor many aspects of the service provided. However, these audits did not identify the issues found with some records held at the service.
Medicine systems and processes were in place. People received their medicines as prescribed.
People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. These were correctly set for the person using them. However, one person’s weight had changed and although the mattress was set for their current needs the care plan did not contain this information.
Staff were recruited safely in sufficient numbers to ensure people’s needs were met.
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. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.
People told us, “Care is good and they know what they are doing” and one relative told us “Mum says the girls are very nice, I find the place generally very good”.
There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records.
Staff had received appropriate training and support to enable them to carry out their role safely.
There were activities provided for people. External entertainers visited the service. Robotic animals, a portable magic table and a wireless speaker provided a variety of activities for people. One relative commented, “I am particularly delighted [Person’s name] is encouraged to take part in craft activities. This has reawakened her artistic talents, and they have been 'reunited' with her skill as a wonderful knitter, which she hadn't done for many years”
Complaints were recorded, and responses were seen. The registered manager told us there were no on-going complaints at the time of this inspection.
People and their families were given opportunities to share their views and experiences. Compliments were received about the service provided at Langholme. Comments included, “From her first day, she was given care that took into account her every need. All the staff show true compassion towards her and other residents” and “My mother was treated with the utmost dignity and care.”
People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.
Visiting healthcare professionals told us, “We have no concerns about this home, it is good,” “The staff know people well and are knowledgeable about them” and “The staff work hard to ensure people’s needs are met. Any changes and they are on to us straight away. I have no concerns about the support provided to people at Langholme.”
Rating at last inspection:
At the last inspection the service was rated as good (report published 10 April 2017))
Why we inspected: This was a planned inspection based on the previous rating
Follow up: We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We found a breach of Regulation 17 of the Health and Social Care Act 2008(Regulated Activities) 2014.
You can see what action we have asked the provider to take at the end of this full report.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the well-led section of this full report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The service is required to have a registered manager and at the time of our inspection a registered manager was in post. 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 and associated Regulations about how the service is run.
The service was split into two units. People who were living with dementia lived in the ground floor unit. People who required residential care had their accommodation on the first floor unit. Each unit had a dining and lounge area and a small kitchen where drinks and light snacks could be prepared. A larger kitchen was used to prepare meals for both units.
People told us they were happy with the care they received and believed it was a safe environment. One person told us; “I tell them if I need anything at all.” A relative said; “My [relative] is well cared for. They are considerate and make allowances for people. They do what they can to assist.”
The service was consistently staffed in line with the staff numbers identified as necessary. Staff told us people’s needs were increasing and it was becoming more difficult to deliver care in line with people’s preferences with the staffing levels in place. We have made a recommendation about this in the report. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role.
New staff completed an induction before starting to work directly with people delivering personal care. Training was updated and refreshed regularly. Staff told us the training they received was good and equipped them to carry out their roles effectively. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.
People received their medicines on time. Medicines administration records were accurate and consistently completed. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians.
People were assessed in line with the Mental Capacity Act (2005) where relevant and the management team followed the legislation to help ensure people’s human rights were protected. Best interest meetings were held when people had been assessed as not having capacity to make specific decisions. These involved other professional and family members to help make sure people’s voices were heard.
Care plans were up to date and relevant and staff told us they were a useful and accurate tool. Any risks in relation to people’s care and support were identified and integrated into the care plans. Risks specific to people’s individual health and social needs were identified. People had regular opportunities to contribute to their care plan with the support of their families if they wished.
An activity co-ordinator was employed to organise planned events. The care staff were supported by additional staff who worked with people to support their emotional and spiritual needs. People told us they were able to make day to day decisions about how and where they spent their time. Care plans and risk assessments recognised the need to support people to maintain their independence.
There was a management structure in the service which provided clear lines of responsibility and accountability. Staff told us they felt well supported and had confidence in the management team and the higher organisation.
People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.
We carried out a comprehensive inspection on 17 February 2015. A breach of the legal requirements was found. This was because the arrangements in place for the administration and management of medicines at the service were not robust. There were gaps in the medicine administration records (MAR) where staff had not signed to show they had given people their medicines at specific times of the day as prescribed. Handwritten entries on the MAR had not been signed by two people to help reduce the risk of errors. Prescribed creams were not recorded when applied by staff, and creams were not dated when opened. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014.
After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focussed inspection on the 26 June 2015 to check they had followed their plan and to confirm they now met legal requirements.
This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langholme on our website at www.cqc.org.uk
Langholme is a care home for older people who are living with dementia. At the time of the focussed inspection on 26 June 2015 there were 36 people living at the service.
There was a registered manager in post. 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.
At this focussed inspection we found the registered provider had addressed some of the concerns found at the last inspection, however there continued to be concern regarding people receiving prescribed creams as prescribed and these being recorded appropriately by staff.
At the beginning of June 2015 the service had begun to use a new method of administering and managing people’s medicines. The service now used a medicine dispensing system (MDS) which placed all prescribed medicines in pharmacy sealed blistered packs pre prepared with doses for each individual. This meant it was clear when prescribed medicines were due and helped ensure medicines would not be missed.
The medicines administration records (MAR) had been fully completed by staff when people had been given their medicines. There were no gaps on these records.
All handwritten entries, which had been entered on the MAR following advice and guidance from medical professionals, had been signed by two staff. This helped reduce the risk of errors.
Some people were prescribed topical medicines such as creams. The MAR was not signed by staff when the cream was applied. This meant is was not clear if people had their creams applied as prescribed. Creams were not dated upon opening, this meant staff were not aware of the period during which the cream was safe to use and when it should be discarded as expired.
One person had been prescribed a cream for a specific period of time after which the treatment should have been reviewed. The review had not taken place and the cream continued to be available in their room.
The action taken by the provider to address the concerns raised in the previous inspection had not been entirely effective. This service remains in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014
Langholme is a care home which provides care for up to 40 people. On the day of this inspection there were 37 people living at the service.
The registered manager for this service had retired recently. There was a new manager in post who was responsible for the day-to-day running of the home. This manager was in the process of applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We carried out this unannounced inspection on the 17 February 2015. We last inspected the home on the 9 October 2013. We had no concerns at that inspection.
We inspected the home over one day. The service comprised of two units. The ground floor unit supported people who were living with dementia. This unit had a large lounge/dining area with corridors running around the outside from which people’s bedrooms were accessed. The doors to people’s bedrooms and the rooms themselves were personalised. However the rest of the unit did not have any additional signage or prompts to help support the orientation of people to different parts of the unit. The first floor unit supported people who required residential care. Each unit had its own kitchenette which provided hot drinks and snacks for people throughout the day. There was a main kitchen in the service which provided main meals to both units.
We looked at the arrangements in place for the administration and recording of medicines at the home and found it was not safe. There were gaps on the medicine administration records (MAR) and two staff had not signed handwritten entries on the MAR to help reduce the risk of errors. Whilst there were quality assurance systems in place the medicines audit had not identified these concerns. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010, which corresponds to Regulation 12 (f) (g) of the Health and Social Care Act 2008 (Regulated Activities) 2014.
You can see the action we told the provider to take at the back of the full version of this report.
Prior to this inspection we received information of concerns regarding staffing levels at the service. During this inspection people told us; “We do have to wait sometimes if they (staff) are busy,” “There is not enough staff on duty.” The service had been through a period of low staffing numbers due to short notice staff sickness absences occurring on a regular basis. The manager had taken steps to address these issues with individual staff and was in the process of appointing new staff. Healthcare professionals told us; “The communication in the home has improved dramatically recently, there is now much clearer leadership. They (care staff) always call me appropriately.”
Staff working at the home understood the needs of people they supported. Staff received training and support which enabled them to be effective in their care and support of people in the home. The new manager had been well supported during her induction. The service had robust recruitment processes in place to ensure new staff were safe to work with older people.
People were happy with the meals. They told us; “The meals are lovely” and “The food here is good.” One family told us whose relative chose to eat their meals in their own room told us “The food is often not as hot as it should be when it reaches (the person) it is a shame.” People could choose from a variety of activities at the service. People told us; “Keep fit and dancing is good” and “We go out in the garden in the sunshine, lovely garden.” There was a visiting chaplain who provided support and guidance for people, families and staff.
The service had good relationships with other external healthcare professionals who ensured effective care delivery for people whenever they needed or wanted it. Families and staff felt they could raise any concerns or issues they may have with the manager who was approachable. People felt their views and experiences were listened to.
We found people's views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.
People's privacy and dignity was respected and people experienced care, treatment and support that met their needs and protected their rights.
People were cared for in a clean, hygienic environment.
There were enough qualified, skilled and experienced staff to meet people's needs
People were protected from the risks of unsafe or inappropriate care and treatment as records included appropriate information in relation to the care provided to people who used the service.
Staff and people who used the service expressed concerns regarding the staffing levels in the home. We saw that staff were busy during our inspection and records showed that at times the planned and / or requested care had not been able to be delivered due to insufficient staff on duty.
The privacy and dignity of people who used the service was promoted and respected by the staff.
People were protected by the systems and procedures in place for the administration of medication.
The environment that people lived in was clean, tidy, comfortable and the control of infection promoted. People were complimentary about the home they lived in and positive comments were made about their bedrooms.