Langley Court Rest Home

About the service

Langley Court Rest Home provides personal care to up to 28 older people, some of whom may be living with dementia. At the time of our inspection there were 24 people using the service.

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

People told us they enjoyed living at Langley Court. People said they were supported by kind, caring and respectful staff who promoted their independence and dignity.

People were supported safely. Risks were identified, assessed and managed. Medicines were managed and administered safely. People’s health needs were met. People and their relatives were involved in making decisions about the support provided.

The home was clean and hygienic. There was a relaxed and friendly atmosphere when we visited. A range of activities were available. People spoke positively about the food provided and could give feedback and suggestions.

The home was well-led and managed. People, relatives and staff spoke highly of the registered manager and his deputy.

Staff were well trained and supported to ensure they had the knowledge and skills to conduct their roles effectively. The staff worked well as a team. Governance systems effectively assessed and reviewed the quality of care provided.

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.

Further evidence was provided following the inspection with care documentation updated to reflect good practice as discussed during our visit.

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 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Follow up

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

We found the following examples of good practice:

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. The provider enabled residents to keep in touch with family members and people's friends through regular phone calls, emails and video conferencing.

All visitors were asked to complete COVID-19 lateral flow test. All visiting professionals on the national testing programme were asked to show proof of their recent COVID-19 negative test. On entry all staff and visitors were provided with PPE. This was to ensure the safety of staff and people. People were supported to see their family in the garden during summer and markings were done in the garden to ensure social distancing.

To ensure people's well-being the provider performed monthly wellbeing assessments using a tool and people's mental state was monitored. If there was a decline in the mental state of people, they were offered extra support.

The provider had an admissions process in place. People had a COVID-19 test within 24 to 48 hours prior to being admitted into the service and were isolated for 14 days following admission to reduce the risk of transmission of COVID-19.

The home had multiple clean areas for staff to don and doff (put on and take off) PPE.

Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The provider had ensured residents who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing.

Further information is in the detailed findings below.

The home had 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.

People felt safe living at Langley Court and spoke positively about the care provided to them. Staff knew people well and treated people with kindness, dignity and respect. Relatives and friends were welcomed and people were supported to maintain relationships with those who matter to them. People spoke about the friendly and homely atmosphere and this was evident on both days we visited.

There were enough staff to meet people’s needs and a consistent team of staff provided continuity of care to the people staying at Langley Court. A new electronic care planning system had been introduced to make sure people’s care and support needs were fully assessed, documented and reviewed at regular intervals.

People were supported to have their health needs met. We saw that people’s prescribed medicines were being stored securely and managed safely.

Staff had good access to training that gave them the knowledge and skills to support people effectively. Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by senior staff and acted upon.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of giving choice and gaining people’s consent before assisting them.

There was a system in place for dealing with people’s concerns and complaints. The registered manager understood their role and responsibilities and positive feedback was received from people and staff about the senior staff team working at Langley Court.

There were systems in place to help ensure the safety and quality of the service provided.

At our last inspection on 18 and 19 August 2016 we found a breach of the regulation in relation to person centred care. Care plans did not always take into account people's long-term care needs and did not always take into account the ways in which people's needs changed over time. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to person centred care. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements and to one area in respect of quality assurance that required improvement. The provider sent us an action plan and told us they had already made the necessary improvements by 3 October 2016. We undertook this inspection to check they had followed their plan, to confirm that they now met legal requirements.

Langley Court Rest Home provides residential care for up to 28 people. At the time of our inspection there were 23 people using the service and 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 inspection we found that the provider had introduced a new care planning system, which was designed to draw attention to any missing or out of date information. Care plans now contained detailed information about people’s care needs, health conditions and preferences about their care. People were involved in planning their care and in regular reviews that took place to ensure that care plans were up to date with people’s changing needs and preferences.

The provider consulted appropriate guidance on care planning and had also introduced systems to help ensure new information relating to people’s care needs was communicated efficiently between staff and added promptly to care plans.

We found the provider had made the necessary improvements to rectify the breach of regulations we found at our last inspection and had also improved their quality assurance systems and we are changing the ratings for the relevant key questions as a result. However, according to our guidance, where a focused inspection takes place more than six months after the last comprehensive inspection, we are not able to change the service’s overall rating. This is because we need to review all of the key questions in order to do so. We will review the service’s overall rating at our next comprehensive inspection.

Langley Court Rest Home is a residential care service for up to 28 people, including those living with dementia. At the time of our visit there were 22 people using 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 inspection we found the provider had taken the necessary action to make sure staff received regular supervision to support them in carrying out their roles. All care staff had received supervision in the last three months and training was up to date. Staff had opportunities to study for relevant qualifications to broaden their knowledge about social care work.

Care plans did not always take into account people’s long-term care needs such as mental health conditions and incontinence. We also found that care plan updates did not always take into account the ways in which people’s needs changed over time. We found a breach of the regulation in relation to person-centred care. You can see what action we have asked the provider to take at the back of this report.

The provider had a range of audits in place to check the quality and safety of the service. These included audits of safety, medicines and care plans. However, the care plan audit had not identified that some information about people’s long-term or changing needs was missing from care plans.

We found the provider was not displaying their CQC rating, which is a legal requirement. However, when we informed managers of this they made sure it was done promptly.

People told us they felt safe. The home had appropriate procedures in place to protect people from abuse and report suspected abuse. Staff were familiar with these. People had risk assessments and management plans in place to identify and mitigate risks to their safety, whilst helping them retain their independence as much as possible. There were enough staff to care for people safely and the provider carried out appropriate checks during the recruitment process to help ensure staff were suitable.

The provider regularly checked the premises, equipment, moving and handling techniques used by staff and fire safety precautions to make sure these were safe and effective. There were procedures in place to manage emergency situations. The provider also had appropriate arrangements in place for the safe storage of medicines. Stock balance records and medicines administration records indicated that people received their medicines when needed.

Staff obtained people’s consent before carrying out care tasks. Care plans contained information to help staff do all that was reasonably possible to help people understand the information they needed to consent to their care. If people did not have the capacity to consent, the provider followed the processes that are legally required by the Mental Capacity Act (2005) to ensure that decisions made about people’s care, including any restrictions on their freedom, were made in their best interests and did not compromise their rights.

People received a variety of food and drink that met their needs and preferences. Where people did not want the dishes that were offered, the kitchen staff met their requests for alternative choices. Staff monitored people who were at risk of malnutrition to make sure they ate enough to stay healthy. People had access to the healthcare support they needed, including referrals to other services when needed.

People and their relatives said staff were kind and caring. We observed staff interacting with people in a friendly and respectful manner. Staff gave people the support they needed when they were upset or in pain. People were involved in planning their care and had the information they needed to make decisions about how they lived their lives. Staff respected people’s choices and supported them in line with the choices they made. Staff respected people’s privacy and dignity. People and their relatives gave examples of how they were supported to remain as independent as possible within the context of the care they received.

There was information in people’s care plans about their preferences around how their care was delivered and how they liked to spend their time. There was a dedicated activities worker and people were able to participate in a range of group and individual activities that met their needs and provided them with meaningful occupation.

The service had a complaints policy in place. People and their relatives told us the manager listened to any concerns they had, although they had not felt the need to make any complaints. The service had not received any complaints since our last inspection.

The provider systematically sought people’s opinions about the service and asked them about ways in which it could be improved. They had made several changes in response to people’s feedback, such as improving the laundry service and the quality of hot meals. The provider had plans to improve the service further and they shared these with people who used the service.

The provider collected information about accidents and incidents. They used this to learn lessons, share these with staff and improve the safety of the service by taking action to prevent them from happening again.

Langley Court Rest Home provides accommodation and personal care for up to 28 older people, many of whom live with the experience of dementia. On the day of our visit there were 24 people living in the home.

The home had a 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 2008 and associated Regulations about how the service is run.

At this inspection we found the provider had taken the necessary action to improve medicines management and risks to people from unsafe medicines practices were much reduced. Medicines were stored, administered, recorded and disposed of safely.

Staff were not always provided with the necessary supervision and appraisal to carry out their roles. However, staff were provided with a suitable level of induction and ongoing training to understand how to support people using the service appropriately. We found a breach of the regulation in relation to how the provider supported staff. You can see what action we have asked the provider to take at the back of this report.

A range of audits was in place for the provider to assess, monitor and improve the service. However, these audits had not identified deficiencies in the way risks relating to hot water temperatures and falling from height were managed, as well as in staff support, supervision and appraisal. The registered manager told us they would review their quality assurance processes in light of our feedback. This was a breach of the regulation in relation to good governance. You can see what action we have asked the provider to take at the back of this report.

The provider made applications to deprive people of their liberty lawfully and notified CQC of the applications and outcomes as required by law. However, staff did not all have a good understanding of their responsibilities under the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards. The provider was aware of this and had planned further training in these topics for staff to improve their understanding.

The provider monitored people’s risk of malnutrition through closely monitoring their eating and drinking patterns. However, the provider did not always monitor people’s weights accurately which meant their systems of identifying people who were at risk of malnutrition were not as robust as they could be. People received appropriate support with their health needs, such as accessing the healthcare professionals they needed to support them.

Generally the provider managed risks to individuals well through their risk assessment and management processes. However, risks to people from hot water temperatures and falling from height were not always managed well because the water temperature at hot water outlets was above 50 degrees centigrade and some windows did not have effective restrictors in place. The provider took prompt action to address these concerns when we informed them of our concerns. Besides these issues other aspects of the premises and equipment were managed safely with suitable checks in place.

The provider and staff understood their responsibilities to safeguard people from abuse. The provider had referred allegations to the local authority safeguarding team for investigation and had notified CQC as required by law.

There were enough staff deployed to care and support people appropriately in the service. The provider recruited staff through robust procedures to check they were suitable to work with people using the service.

Staff were kind and compassionate and treated people with dignity and respect. Staff understood the people they were working with including their preferences. People were encouraged to be involved in their own care. The provider regularly reviewed people’s care to check people were satisfied and that their care package was still suitable for them. People were provided with a range of activities they were interested in.

The provider had a suitable complaints procedure in place and people and their relatives were confident that the registered manager would respond appropriately if they made a complaint.

The provider involved people using the service, their relatives and staff in the running of the service. There was clear leadership presence in the home and resources were available to improve the home.

People had been asked how they preferred their personal care to be given and that this had been recorded in their care plans. Support with personal care included having staff of the same gender to assist people wherever possible.

We found that care plans and assessments had been carried out with the involvement of the individual, staff and family members where appropriate. Daily records were up to date.

We saw that improvements had been made to the office area of the home, with new filing cabinets in place and previous clutter gone. We saw records had been updated and cleansed of old and duplicate material and safely stored in filing cabinets.

We saw that food was prepared by the in-house cook and was presented individually to people. The food was appropriately hot, had an appropriate mix of vegetables and carbohydrates and was provided in sufficient quantities. We saw that care staff ensured that water jugs and glasses were placed in such a way that people could reach them easily.

We found that there were procedures in place to ensure visitors to the home used a disinfectant gel before meeting people. There were policies and procedures in place regarding infection control and staff were seen to wear appropriate clothing during their work. Staff we spoke to were enthusiastic about their role and demonstrated a sound awareness of the needs of individuals. They also confirmed that they had undergone induction programmes when they started work and were supported to develop their training and personal development.

We saw that there was a regular system of asking people and their relatives for feedback about the service and that the manager had daily contact with people and visitors. we also saw that the provider had regular contact with the home and the people who lived and worked there.

We looked at a sample of records and care plans. These showed that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We observed that people were supported to be able to eat and drink sufficient amounts to meet their needs and received appropriate assistance where required. People had the choice of eating in the main dining area, at a table in the lounge or in their own rooms.

The home had a procedure in place for the reporting of any concerns regarding safeguarding.

We found that people were protected from the risk of infection because appropriate guidance had been followed and they were cared for in a clean, hygienic environment.

Staff we spoke with confirmed that they had been checked and interviewed prior to employment in the home. One new member of staff confirmed that they were about to go on an induction course, while other staff told us that they had received updated training in areas such as safeguarding, moving and handling and medication administration.

The provider had an effective system to regularly assess and monitor the quality of service that people receive, which included seeking the views of relatives and staff.