Langham Manor

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated as requires improvement. This meant that some aspects of the service were not always safe and there was a risk that people could be harmed.

The provider did not ensure that the staff received the required training to ensure they had the skills and knowledge needed to support people’s needs. The storage and administration of people’s medicines needed strengthening. Shortfalls had been identified with the fire safety systems for a significant period and this had not been prioritised or addressed. Whilst we did not see any evidence of negative impact to people, the risk of harm was possible.

People were supported by staff who knew them well. Whilst we received some variable feedback on there being enough staff, most people told us that they received the care they needed. Risks were assessed and systems in place to mitigate risks and monitor people’s needs. This included the provision of specialist mattresses and regular repositioning to promote skin integrity The registered manager had systems and processes in place to review falls, unintentional weight loss, accidents and pressure injuries. Incidents and accidents were reviewed to identify any trends or themes.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us that communication was good with the management team, and they were kept up to date with changes in their relative’s needs and any incidents which occurred. The registered manager responded positively to feedback from people and relatives, and we saw that they had arranged for a family member to meet with the catering manager to discuss their family members nutritional intake.

The registered manager held daily meetings with heads of departments to review what was happening in the service and any escalating risks to people’s wellbeing. Clinical meetings were also held to review needs and identify learning.

Incidents and accidents were reviewed to identify any trends or themes. The registered manager described the actions that they took to reduce the likelihood of a recurrence and to learn lessons from what happened. These actions included the provision of special equipment and the referral to health professionals.

The registered manager was aware of their Duty of Candour responsibilities and told us that they were committed to the development of the service and a culture of learning. However, they were not able to provide a clear rationale as to why safety issues had not been promptly resolved by the provider.

Processes in place were not fully effective and did not always promote a learning culture where people’s safety was prioritised. Training records for example showed significant gaps in knowledge and shortfalls in fire safety arrangements had been identified for some time. The provider was aware of fire safety shortfalls but had not addressed the issues in a timely way. This meant that learning processes were not effective.

People admitted to the service were supported to settle and transition into their new environment. People told us that they had good access to GPs and other health professionals.



Relatives said that they were involved in decisions and assessments of their family members needs and said they were kept up to date. One described how their relatives’ needs had increased, and they were moved to a different part of the service. “I was very involved in the move, [person’s relative] became unwell and lost mobility, they now need to be hoisted. The Deputy Manager is very easy to communicate with.”

The GP practice undertakes weekly visits. Staff described how they supported people alongside input from other health care professionals. Wellbeing was promoted throughout the day with a programme of activities.

We sought feedback from partner agencies as part of our assessment and they told us that where concerns had been raised, they had been investigated and responded to by the service.

Initial assessments, care plans and risk assessments helped to determine people’s needs and any actions to take to mitigate and monitor people’s needs. For example, people with unintentional weight loss were weighed weekly and offered a fortified diet.

People at risk of pressure ulcer had appropriate pressure relieving equipment in place. Records showed that people were assisted to reposition at regular intervals in line with their risk assessment. Not all risk assessments however documented the slings that people needed when being assisted with moving and handling. The registered manager agreed to review these risk assessments to ensure that they provided staff with the guidance they needed.

Records showed that referrals had been made to other health professionals such as the Speech and Language service and dieticians when deterioration in people’s wellbeing was identified. Information about people’s clinical risks were discussed at the weekly clinical risk meetings and records were in place to monitor how the risks were being reduced. Daily meetings between staff at heads of department level helped ensure information was shared.

People told us that they felt safe living at the service. One person told us, “I have been here 4 months, it is very nice here, staff very nice, food is ok, and the place is very clean.”

Staff spoken with had a good understanding of risk and were aware of the importance of escalating concerns and what constitutes abuse. However, they were not aware of local safeguarding protocols and there was no information on display on how to guide staff. The registered manager told us that they would immediately address this.

Throughout our visit we observed no staff practice which would give us a concern for people’s safety.

There were policies on safeguarding and whistleblowing in place. The registered manager outlined the actions they had taken when concerns were identified including escalating those concerns to the local authority safeguarding team. Investigations were carried out and appropriate actions taken. Concerns over people’s safety were discussed and shared as appropriate with the team so lessons could be learnt.

Relatives and people using the service told us that they were involved in discussions in relation to minimising risks to their safety and had confidence in the staff. One person told us, “Always two [staff] doing the hoist, it is high up, but I do feel safe.” However, there were discrepancies and gaps within care planning which meant that people could experience inconsistent care and risk management. For example, it was not always clear what moving and handling equipment staff should use and how people’s anxiety and distress should be managed.

The registered manager told us that an assessment of risk was undertaken as part of the admission processes. However, we found that staff were unable to locate the care plan and risk assessment for a newly admitted resident. The registered manager told us that this was due to a technical issue and agreed to follow up and ensure access for the staff providing support.

Staff had a good understanding of people’s needs and people were observed to have access to equipment such as pressure relieving mattresses and cushions to reduce the risk of harm. We observed people mobilising or being supported to mobilise safely. People had good access to drinks and around the home there were snacks and hydration stations as well as a café on site. Staff monitored people’s food and fluid where necessary and we observed appropriate levels of supervision at lunch time.

The registered manager had systems and processes in place to monitor review and manage risks.

Falls were reviewed along with unintentional weight loss, accidents and pressure care. Reasons for falls were analysed including a breakdown of where they occurred and at what time. Information sharing across the home involved all heads of department and regular meetings helped to ensure good communication.

However, the systems were not fully effective as they had not identified and addressed some of the issues we identified as part of this assessment.

People and their relatives spoke very positively about the environment and described it as aesthetically pleasing and comfortable.

Staff we spoke with told us they felt the environment people lived in was of a high standard and safe. They were not aware that risks had been identified about fire safety systems and that this could impact people in the event of a fire.

There was a maintenance person who dealt with any environmental concerns staff raised to them. Doors were key coded, and CCTV was in place in the entrance and car parking area as part of the services security systems.

Staff confirmed that they had access to a range of equipment including hoists and other mobility aids. However, a number of staff raised concerns about the availability of equipment on some floors where dependency levels were higher. We asked the registered manager to review access to equipment.

The home looked well maintained and clean. The environment had been designed to meet people’s needs, with plenty of facilities such as a cafe, cinema room, private dining room, adapted bathrooms and several communal living areas. We observed various measures in place to help keep people safe. For example: wardrobes were fitted to walls to prevent entrapment and people had access to call bells in case of falls.

However, we did observe some potential risks to people’s health and wellbeing at the service. A storage room containing electrical cables and hot water pipes had been left open which was a hazard and meant people could enter and potentially cause themselves harm. Glass and other ornaments were accessible in bathrooms which could pose some risks to some people. We asked the provider to take action to review these risks and they subsequently confirmed that they had done so.

Processes to ensure safety were not fully effective as audits and health and safety checks had not ensured that safety issues had been escalated and addressed.

Records showed that issues had been identified with fire safety systems some ten months previously and while this had been escalated to the provider this had not been resolved. This meant that people were placed at risk of harm. The provider assured us on the day of the inspection that they would immediately address these issues. However, we also contacted the local fire officer who sent the provider a letter of deficiencies asking them to take action.

Issues were also identified with the gas safety certificate, the servicing of beds and the syringe driver. The provider took immediate steps to address these issues, but it remains a concern that the processes are not effective at identifying and prioritising these safety issues.

Some risks associated with the environment had been minimised. Checks were in place for window restrictors and equipment such as hoists and slings had been serviced to ensure they were safe to use.

People were supported by staff who knew them well. Whilst we received some variable feedback on availability of staff, overall, most people told us that they received the care they needed, although sometimes they had to wait for a member of staff to become available. One person told us, “I am perfectly well looked after the staff are all very good. I feel guilty for using the call bell, they all look so busy. We have activities such as bingo, curling, painting, The [activity coordinator] is lovely. I tell them when I want a bath, and they fit me in. I don’t think they have enough staff they are busy all the time. They apologise if they take a while to get to you.” Another told us, “Buzzer very good, except at night, I have to wait if they are in another part of the house, happens like that now and again and you wait 10 minutes. You are just left hanging until someone comes…..The girls are really nice, sometimes when they have got time, they chat, they move the staff around but not on a regular basis.”

Most staff told us that there was sufficient staff available to support people however issues sometimes occurred when staff were unwell as they had only a small team of bank staff and were not using agency staff.

The registered manager told us that staffing levels were monitored closely, and changes had recently been made to the administration of medicines in the morning to ensure that nursing staff had the time they needed to assist people.

Staff confirmed that they received induction training when they commenced employment which consisted of practical training in moving and handling and fire safety, eLearning and shadowing more experienced colleagues. Staff gave us variable feedback on the quality of the training and told us that they relied on training which they completed at previous care services for their knowledge. This reflected the shortfalls that we found on training records and gaps in staff knowledge. Whilst most staff we spoke with were experienced the lack of a robust training system had the potential to place people at risk.

Staff told us that they received ongoing supervision and yearly appraisals.

We carried out observations across two days and noted that staff were generally attentive to people’s needs. Call bells were answered promptly. Mealtimes was well organised and there were sufficient staff available to support people and ensure that they were assisted appropriately.

Dependency tools were in place which collated data about people’s primary need and the support they required for example with moving and handling, assistance with eating and drinking. This information was reviewed and used to determine staffing levels.

The management team carried out recruitment checks prior to staff working with people to ensure they had the right level of qualifications, skills and character to meet the needs of the people using the service. We viewed recruitment records and found appropriate systems in place including the taking up of references and disclosure and barring checks to check for previous convictions and references.

The process in place to ensure oversight of staff training and competency was not effective as it did not ensure that staff received the training that they needed for their role. The training matrix showed significant shortfalls in staff training and there was a lack of evidence to demonstrate that staff had the required skills to support people’s needs.

Only a small proportion of care staff had completed training in dementia care, less than half the staff had competed training on diabetes and only four care staff had completed training on end of life care. The service supported people requiring palliative care and with needs arising from dementia and diabetes.

There were also shortfalls in the oversight of training and competency assessments of nursing staff. For example, it was not clear when nursing staff had completed training in the use of the syringe driver. The registered manager told us that they intended to undertake a clinical audit of skills and training and would ensure that a training tracker and competency overview was introduced.

Staff told us that they were not paid for time to undertake training required. When we raised this with the provider, they told us that they had reviewed their policy and moving forward would reimburse staff for attending eLearning.

People experienced living in a clean, well-ordered environment with a lack of odours. People told us staff washed their hands and followed hygiene protocols.

We spoke to one of the domestic staff who told us they were well supported and had access to all the equipment they needed. Staff told us they followed procedures to protect people from the risk of or spread of infection. They confirmed they wore protective personal equipment (PPE) such as gloves and aprons when needed.

Over our two-day site visit we noted people’s rooms were airy and spacious. The rooms were clean and well maintained, as was the home throughout. Staff were observed washing their hands and using PPE appropriately.

A housekeeper oversaw a team of staff and cleaning schedules and audits were completed. There were protective personal equipment stations where staff could access gloves and aprons.

People told us that they received their medicines as prescribed and expressed confidence in the skills of staff who were administering them. However, we found processes regarding storage and administration should be strengthened to ensure people are protected from harm.

Staff handling people’s medicines received training and had their competence assessed regularly to ensure that they were safe to do so. Staff conducted regular checks of medicines to ensure that people received their medicines as prescribed.

We observed that staff followed safe procedures when giving people their medicines. Records showed that overall people received their oral medicines as prescribed.

Oral medicines were kept safely and at correct temperatures. However, people’s topical medicines were not being kept securely in their rooms. The service had not considered the risks around people accessing them and causing themselves accidental harm.

We found that there was care planning information about people’s medicines and how they were to be given to individual people. However, we noted that improvements could be made to ensure this information is more readily accessible to staff at the time they were giving people their medicines.

When people were prescribed medicines on a when required basis (PRN), for some, there was a lack of person-centred and detailed written guidance for staff to refer to ensure they were given consistently and appropriately. In addition, when medicines were given in this way, records were not detailed about why the medicines were needed.

When people were prescribed medicated skin patches there were additional records to show that the sites of application of some patches, but not all, had been appropriately varied to reduce the risks of adverse skin effects from them. In addition, there was a lack of records for the removal of previous patches to ensure safety.