We carried out a comprehensive inspection of this service in March 2016 and found the provider was not meeting the legal requirements in relation to standards of care and welfare for people who lived at Langdale Nursing Home. Risks associated with people’s care had not always been assessed, people had not always consented to the care they received, records held in the service were not always secure, accurate and complete and staff did not always receive adequate supervision and training to support them with their working role. The registered provider sent us an action plan detailing how they would address these concerns and said they would be compliant with the Regulations by 30 June 2016.

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.

This unannounced comprehensive inspection took place on 14 and 16 March 2016. Langdale Nursing Home provides accommodation and nursing care for up to 39 older people. During the inspection 38 people were being accommodated. The home cares for a diverse group of people. At the time of inspection 11 of the 38 were people under the age of 60 and the needs of people included those living with dementia, brain injury and multiple sclerosis.

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.

We spoke with seven people who used the service, five relatives and six members of staff. We found that people who used the service were included in the planning of their care and were treated with dignity. Their choices were respected and the staff care for people in an unhurried and relaxed manner. The plans also detailed people's physical and emotional healthcare needs. Evidence that we saw showed us that people were supported by a caring, experienced nursing and support team. People using the service told us that they were happy with the care and support they received and they were positive about the manager and staff team.

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.

People using the service told us that they were happy with the care and support they received and they were positive about the manager and staff team.

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.

We spoke with six people who use the service and they told us that they found the home comfortable. One person told us the home was “a good place.” Another person told us: “They take care of me here.” She told us that members of staff “spend time with me and look after me.” One relative told us: “My grandmother has made great progress since she has been here. She has put on weight and is more active than ever before.”