Langley Lodge Residential Home

Langley Lodge Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 20 people using the service. Langley Lodge Residential Home can accommodate up to 20 people in individual or double bedrooms in one adapted building. It is a two-storey building with a stair lift to access the first floor.

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

Staff took action to keep people safe from possible harm. However, actions taken were not always done in the least restrictive way. This included measures to restrict some people's movement around the service. This meant that people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The registered manager took action immediately to make the necessary improvements.

Fire policies and risk assessments had not considered all the necessary information to ensure that the risks to people’s safety had been reduced as much as possible in the event of a fire. We informed the fire service of our concerns and they completed a full audit and issued a Notice of Deficiencies.

The governance system had failed to identify the areas for improvement that we found during the inspection. Potential new staff to the service underwent checks to make sure they were suitable to work with people. However, a lack of auditing of these records showed there were gaps in some staffs' employment history that had not been explored. Not all staff had completed their refresher training when due. The registered manager had not always completed notification of certain events to the CQC as required. The manager had not reviewed the tool they used to determine staffing levels to ensure that the number of staff working was appropriate to meet the needs of people in a timely and safe manner. Feedback was mixed about if the staffing levels were adequate.

Staff were following current government guidance around good infection control procedures. Medicines were being administered as prescribed. Written procedures were in place to advise staff when to administer “When required” medications. Accidents and incidents were being analysed to ensure that themes and trends were identified and the necessary action taken to prevent a recurrence.

Staff used their training knowledge to safeguard people wherever possible and support people to keep safe from poor care and abuse. If staff had any concerns about people, they knew where to report this both internally and outside of the service. Staff spoke favourably of the management team and stated that they felt supported in their roles.

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 (report published November 2018).

Why we inspected

We received concerns in relation to restricting people’s movements and choices in the home and the quality of the service being provided. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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, effective and well led sections of this report.

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

As a result of our findings the registered manager has taken immediate actions to implement the required improvements and mitigate risks to people’s safety.

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

Enforcement and Recommendations

We have identified breaches in relation to reducing risks to people, restricting people’s liberty and quality assurance. Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice.

Staff checked their temperatures before starting work, there were hand washing facilities and a place for staff to change into their uniforms. All staff and people who lived at Langley Lodge took part in the providers regular testing programme.

At the time of our inspection the home remained free from the COVID-19 virus. Staff supported people wearing personal protective equipment (PPE), this promoted good infection control practices to keep people safe.

Staff completed training about infection control, hand washing and putting on and taken off PPE. The provider ensured that staff understood their training, their door was always open should staff require guidance or support.

The building looked clean and free from clutter. Appropriate cleaning products were used, to ensure good infection control was maintained. All frequent touch points were cleaned regularly, for example, door handles.

The provider told us that they were working collaboratively with colleagues from the Local Authority and CCG (Clinical Commissioning Group) They shared any relevant updates with staff, people and their families.

Langley Lodge Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 18 people using the service. Langley Lodge Residential Home can accommodate up to 20 people in individual or double bedrooms in one adapted building. It is a two-storey building with a stair lift to access the first floor.

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 2008 and associated Regulations about how the service is run.

The service was not always safe. Medicines were not always administered as prescribed and the recording of some medicines was not accurate. Healthcare professional advice had not always been sought when errors occurred. Incidents of potential neglect had not been referred to the local safeguarding authority. Risks to people were identified but they were not always well managed. This put people’s safety at risk.

We have made a recommendation about the management of some medicines.

Sufficient staff were in post and the recruitment process for new staff had helped ensure that only suitable staff were employed. Lessons were learned when things had not always gone well. Staff adhered to the provider’s policies in maintaining a clean environment.

The service was effective. People’s needs were met by staff who had the right training and skills to do this. People at healthily and they had sufficient quantities of food and drink. People were enabled to access health care services. People were 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. The registered manager worked with others involved in people’s care, such as health professionals when people moved into the service so they received consistent care.

The service was caring. People received compassionate care from staff who took account of each person’s care needs. People’s privacy and dignity was promoted and respected. People were given support and information to access advocacy services. Staff involved people in their care with care and consideration of how they wanted to be cared for. People were cared for without discrimination. People’s confidential records were held securely.

The service was responsive. People received person centred care that was based upon their what their preferences were. People could be as independent as they wanted to be. Technology was used to enhance the quality of people’s lives. People concerns were identified and responded to and this helped drive improvement. People, relatives and staff, when required, had the support they needed if any person needed end of life care.

The service was well-led. The registered manager led by example and ensured the staff they supported had the right skills and values. Staff worked as a team to help people and each other. Quality assurance and governance systems were mostly effective in identifying and acting upon improvements when these were needed. People had a say in how the service was run. Staff were given feedback and support with their work in a positive way. An open and honest staff team culture was in place. The registered manager and staff worked in partnership with others who contributed to the quality of people’s care.

Further information is in the detailed findings below.

This unannounced inspection took place on 3 March 2016.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff had been trained on how to protect people from harm. They were knowledgeable about applying this information and were confident in recognising potential signs of harm. People's individual care needs were met by a sufficient number of suitably qualified staff. Only staff whose suitability to work with people living at the service had been ensured were offered employment. The provider had systems in place to assess and manage risks to people’s safety.

People's medicines were managed and administered in a safe way. People who required their medicines to be administered in a particular way were supported to take their medicines as prescribed. An effective induction process was in place to support new staff. Staff were provided with training which was kept up-to-date according to their role. People were supported and cared for in a safe way based upon the risk assessments which had been completed and regularly updated.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered and deputy manager were knowledgeable about when an assessment of people’s mental capacity was required. Appropriate applications were in progress to lawfully deprive some people of their liberty. However, not all staff had an understanding of the MCA and how a DoLS would be determined. This meant that there was a risk that people could be provided with care that was not in line with the MCA and DoLS code of practice.

People were given choices of their preferred food and drink options. This included a choice of appropriate diets for those people at an increased risk of malnutrition, dehydration or weight loss. People were supported to access a range of health care services and staff were prompt in identifying people's health needs.

People's care was provided with compassion by staff who showed genuine concern for people's wellbeing. They, and their relatives, were involved in the review of people’s individual care plans. People’s privacy and dignity was respected by staff who were skilled in respecting people's privacy.

People were provided with information on accessing independent advocacy services if any person required this support.

People were given various opportunities to help identify and make key changes or suggestions about any aspects of their care. Some opportunities were missed to support people with their care needs which could benefit their uptake of hobbies, interest and social stimulation.

A range of effective audit and quality assurance procedures were in place and these were used to help drive improvement. Information regarding the running of the service and people’s care was shared through a range of forums including residents’, managers’ and staff meetings.

All of the people who we spoke with were satisfied with the quality and standard of their support and care. Assessments of people's risks and health and social care needs were carried out and planned. People received their support and care as planned.

Arrangements were in place to ensure that people who used the service had access to safe equipment.

Staff were supported to do their job, which they said was rewarding. There were arrangements in place for staff to attend training relevant to their role.

People had access to up-to-date information about the services provided at Langley Lodge Residential Home.

There was a system in place which allowed people to make their concerns and complaints known. People who we spoke with said that they knew who to speak with if they were unhappy about something and were satisfied with the response that they received.

We found that that remedial action was taken to minimise people's health risks associated with acquired infections. This included improved cleaning systems of bathing equipment and the removal of communal creams and toiletries.

There were some improvements in staff training and instruction regarding cleaning products and management, and control of infection. However, more formal infection control training had not been made available. This is an area where improvements could be made to ensure that staff had up-to-date knowledge to provide people with continued safe and appropriate care.

The infection control policy remained out-of-date and was not revised by the timescale set by the provider for completion. We were advised that this delay was due to other priorities that had taken place. The manager advised us that the revised infection control policy would be made available by 21 September 2012.