We carried out a review of the data available to us about Langdale Nursing Home 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 Langdale Nursing Home, you can give feedback on this service.
Langdale Nursing Home provides accommodation, nursing and personal care for up to 39 older people, some of whom live with physical disabilities. Accommodation is arranged over two floors with stair lift and passenger lift access to all areas. At the time of our inspection 36 people lived at the home.
People’s experience of using this service and what we found
Medication was dispensed and administered in a safe manner. We saw staff administered medicines to one person at a time, to minimise any risks associated with this process. Staff had received formal training to ensure they were confident and competent to give people their medicines.
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.
Family members told us the home provided a safe environment for people and described how the service had clear COVID protocols. These minimised the risk of infection and yet allowed visiting within a custom-built chalet, a summer house in the garden, and inside in a dedicated COVID secure room. Even prior to COVID, relatives said that environmentally the home was safe, and that people were treated very well by staff and other people living in the service?
People were kept safe from avoidable harm and abuse. The provider had safeguarding procedures in place, which staff understood and followed. Risk assessments reflected how care should be provided to minimise any risks to people; they were regularly reviewed to adapt the level of support needed in response to people's changing needs.
People and their relatives told us they were happy with the variety and choice of meals available to them. Regular snacks and drinks were available between meals, to ensure they received adequate nutrition and hydration.
People received care and support that met their needs. People's care and support needs were assessed, and good practice guidance was followed. People were involved in the planning and review of their care and were encouraged to express their views, preferences and wishes regarding their care, support and treatment. This included any end of life wishes they had.
A professional told us they were always welcomed and attended to by staff when they visited people living at the home. They also told us the staff communicated very well, they listened to advice and always carried out any instructions they left. They said the home always acted promptly and professionally and made referrals to their service in a timely way. Hygiene at the home was reported to be of a good standard and the home always appeared to have enough staff. They stated the staff appeared to work as a team and that any information the home shared was relevant and good.
The provider had a robust auditing system in place to monitor quality assurance. Records demonstrated any identified issues were acted upon in order to make improvements. The registered manager and provider had systems in place to obtain the views of people who lived at the home and their relatives.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 29 July 2019) and there were two breaches 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 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 and Effective due to its rating of requires improvement.
The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion but were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langdale Nursing Home on our website at www.cqc.org.uk.
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.
The home provides accommodation, nursing and personal care for up to 39 older people, some of whom live with physical disabilities. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 39 people lived at the home.
People’s experience of using this service and what we found
The provider lacked effective governance systems to effectively monitor the service and drive the necessary improvement. At times, there was a lack of detailed records regarding medicines, recruitment and complaints management.
People were not sufficiently protected against the risk of avoidable harm because potential risks to people’s health, safety and welfare were not managed safely all of the time.
Consent had not been sought in relation to certain aspects of care and where people lacked capacity to make decisions, a mental capacity assessment or best interest decision meeting had not taken place. We have made a recommendation about this.
Despite this, people were happy living at Langdale Nursing Home and people told us they felt safe. There was enough staff to meet people’s needs. People received their medicines as prescribed and the environment was clean.
People were positive about the food and drink. Where they needed external health input they were supported to receive this. People were cared for by staff who were well supported and received appropriate training and supervision to meet people's needs effectively.
People were supported by staff who were kind, caring and who understood their likes, dislikes and preferences. People had access to a range of activities and were supported to maintain links with the community and those important to them.
The culture of the home was positive and people lived in a homely and friendly environment. Staff felt valued and listened to and told us they liked working at Langdale Nursing Home. People and staff were positive about the management team.
The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.
At this inspection, we have identified two breaches in relation to governance and managing risks.
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 28 April 2017)
Why we inspected
This was a planned inspection based on the previous rating.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We carried out an unannounced inspection of the home on 18 April 2017 and found the registered provider had taken sufficient steps to be compliant with all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The home provides accommodation, nursing and personal care for up to 39 older people, some of whom live with physical disabilities. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 39 people lived at the home.
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.
Medicines were managed safely and effectively in the home. Risks associated with medicines had been identified and actions taken to reduce these risks.
Risks associated with people’s care had been identified and plans of care were in place to reduce these risks.
People were supported by staff who understood how to keep them safe, identify signs of abuse and report these appropriately. Staff recruitment processes were robust although records of these processes were not always orderly. We have made a recommendation about the recording of staff recruitment. Staff received sufficient support, training and supervision in the home to meet the needs of people.
People received freshly prepared nutritious food that met with their needs and preferences.
People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.
People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.
Care plans reflected the individual needs of people and the risks associated with these needs.
People were supported to participate in a wide range of events and activities of their choice.
Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.
The registered manager provided strong and effective leadership whilst encouraging staff to develop in the service. They promoted open and transparent communication in the home where staff felt able to develop their skills and improve care for people.
The service 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.
The service was last inspected in November 2013 and at this the service was found to be compliant with the regulations looked at.
Staff understood the principle of keeping people safe, but we found serious injuries had not been reported to external bodies or investigated by the registered manager meaning people may not have been safeguarded. Some assessments had been completed as part of the care planning process, but these were not specific to individuals; which meant where a risk had been identified risk assessments had not always been completed. For example almost everyone had a standard risk assessment for falls, but not for specific risks relating to their individual risks. This meant people could have risks, for example aggressive behaviour, but staff were not aware of these risks. Staffing levels met the needs of people, with the home having a static staff group. There was a training programme but not all staff had in date training in all areas, which meant all staff may not have the knowledge to meet people’s needs. Recruitment checks had been completed before staff started work to ensure the safety of people. Medicines were administered and stored safely.
Staff had a basic knowledge of the Mental Capacity Act but people’s records did not show people’s capacity to make specific decisions had been assessed. This meant people did not have their mental capacity assessed and restrictions may have been placed on people without their agreement or being in their best interests. People enjoyed their meals and were offered a choice at meal times. People were supported to access a range of health professionals.
People did not always have their needs planned in a personalised way, which reflected their choices and preferences had been considered. This meant staff may not always have the best information on how to meet an individual’s needs and preferences. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.
People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the registered manager and were clear about their roles and the values of the home. Records were not always accurately maintained and this was not an effective part of the quality audit process. Notifications were not being submitted as required.
We found breaches in six of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulation 2009. You can see what action we told the provider to take at the back of the full version of the report.
Relatives of people who use the services told us that 'it's a very happy home, I wouldn't hesitate to recommend it to anyone', 'The staff are excellent' and 'It's a friendly atmosphere, they genuinely care for the people here'.
The service had a very high standard of cleanliness and had successfully contained and treated a contagious infection.
There was sufficient staffing levels to ensure people's needs were addressed effectively. Staff were suitably qualified to undertake their roles and there was a complaints procedure available if it were required.
Comments from people using the service included. 'It's really fine here, they look after me well, my food is fine and the staff are lovely. I choose the way I want to spend my day.' Another person said. 'Wonderful care because they look after you so well, we get nice food and the staff are very, very nice.'
Each person living in the home had a holistic plan of care and nursing plan in place that guided staff to their individual needs and wishes. The plans also detailed people's physical and emotional healthcare needs.
The home's staff worked with a variety of healthcare professionals including speech and language and occupational therapists. We were shown that advocates and specialist consultants were used where appropriate.
We saw that people had the specialist equipment they needed in order to ensure their safety and wellbeing.
People were protected from risk of abuse as they were supported by a staff team who had the appropriate knowledge and training on safeguarding adults.
Evidence that we saw showed us that people were supported by a caring, experienced nursing and support team.
People were very positive about the manager and staff team and said that they were kind and friendly.
A regular cycle of quality audits was undertaken to ensure that the home was kept under review.