About the service:

Langdales is a care home for up to 26 older people or people living with dementia. Accommodation was arranged around the ground and first floor with office accommodation on the second floor. Each person had their own bedroom and shared the lounges, dining room and other facilities. There was a small garden area to the rear of the building. There was a passenger lift for ease of access and the home was wheelchair accessible. At the time of the inspection 17 people lived at the home.

People’s experience of using this service:

People told us the registered manager and staff were kind, friendly and caring and they felt safe at Langdales. There had been a change of registered manager since we last inspected. People were positive about the way she ran the home and the changes she had made.

People were supported by staff who had been recruited safely, appropriately trained and supported. Staffing levels were sufficient and staff appropriately provided safe care. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff involved people in planning their care and encouraged them to make choices. They supported people to manage risks and stay safe and to remain as independent as possible. People were supported to air any concerns they had and the registered manager took action on these.

People were helped 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. Staff assessed people's capacity to make decisions and supported them with making decisions. making. People were encouraged to air their ideas, views or concerns. Staff were guided in how to manage complaints.

Staff supported people to eat healthy nutritious food and drink sufficient fluids and knew their likes and needs. Staff helped them to attend healthcare appointments to assist their health and wellbeing. They understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. Their end of life wishes were recorded so staff were fully aware of these.

The home was clean and maintained and staff practised good infection control. Water temperatures were at a safe temperature and equipment had been maintained. People had been able to personalise their rooms with their own furniture and personal effects.

Staff worked in partnership with other organisations to make sure they followed good practice and

people in their care were safe. The management team used a variety of methods to check the quality of the service and develop good practice.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 31 May 2018).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if any issues or concerns are identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection visit took place on 12 April and 18 April 2018

This is the first inspection for Langdales since a change of ownership. Diamond Care Homes Langdales Ltd took over the home from another registered provider and became the registered provider with the Care Quality Commission (CQC) on 18 July 2017.

Langdales is a care home that provides accommodation to up to 26 people who require personal care and support. Some of whom are living with dementia. Accommodation was arranged around the ground and first floor with office accommodation on the second floor. There was a small garden area to the rear of the building. There was a passenger lift for ease of access and the home was wheelchair accessible.

At the time of the inspection 17 people lived at the home.

There was a registered manager in place. 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 we spoke with told us they felt safe and cared for at Langdales. They told us they were satisfied with the care they received and were supported by staff who treated them well. One person told us, “I feel safe here. The girls make sure of that.” Another person said, “I love it here. I feel better and safer here than I did at home.” However, although we saw good practice we also saw areas of care that reduced people’s safety.

Medicines were not managed safely. Medicines were not always stored correctly, or administered according to the home’s procedure or good practice. This put people at risk of not receiving their medicines.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safe care and treatment) as the registered provider had failed to ensure the proper and safe management of medicines;

Staff did not always take the need for confidentiality of people’s information into account. We saw on one occasion people were asked personal questions in a communal area. No other people were present in this area but there was the possibility of being overheard. Also on day one medicines records and other charts were not always stored securely so could possibly be accessed by people other than those who should see them.

We have made a recommendation about ensuring confidentiality of information.

Although care plans were personalised, they did not have all relevant information about each person’s care in them. This reduced the knowledge of staff who were unfamiliar with the individual.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the registered provider had failed to ensure records maintained were accurate and reflected people’s needs.

The service had not discussed with people and documented their preferred end of life wishes.

We have made a recommendation about this.

We saw there had been recent changes of area manager for the organisation, and the way audits to assess and monitor the service were completed. The recent audits to assess and monitor the quality of the service had shown where gaps and omissions were. Actions in response to the audits had started but were still on-going when we inspected.

We have made a recommendation about continuing auditing the service and completing any actions highlighted promptly.

We looked around the building and found it had been maintained, was clean and hygienic. The design of the building and facilities provided were appropriate for the care and support provided. However when we checked a sample of water temperatures, we found the water was very hot in two rooms. The registered manager took immediate action, checked all water outlets to ensure they were safe and contacted a plumber to arrange further checks. Equipme

This inspection visit took place on 18 July 2017. The visit was unannounced.

The inspection was prompted in part by notification of an incident, when the location was owned by a different provider, following which a service user died. This incident is subject to a separate investigation and as a result this inspection did not examine the circumstances of the death. However the information shared with CQC about the incident indicated potential concerns about the management of health issues. This inspection examined those risks.

Since the incident the ownership of Langdales changed hands in April 2017. The registered provider is now Diamond Care Homes Langdales Ltd. We carried out this focused inspection to ensure the new provider was managing people’s health issues. This report only covers our findings in relation to the potential concerns. As they have not yet had a comprehensive inspection as this new organisation, they have not been formally rated.

We spoke with four people who told us they felt safe and ‘well looked after’ by the staff team.

We looked at care and support of people who needed assistance with personal care. We checked care records of people who were at risk of skin breakdown and pressure sores. We saw care plans, risk assessments and daily reports indicated checks had taken place. Repositioning charts to record the person’s positional changes were used where needed.

Pressure aids were in place where people were at risk of developing pressure sores. Action was taken and support and guidance sought where people were at risk of tissue damage.

We looked at how staff received information and guidance. We saw staff received supervision and staff meetings took place with records kept. Any care issues or changes were highlighted to staff in both individual supervision and staff meetings. Staff training in the care of people at risk of pressure sores had been sourced and arranged so staff had up to date knowledge of current care and guidance.

Audits were frequent, documented and any issues found on audits acted upon promptly. Audits were forwarded to the directors of the organisation who checked actions were taken where needed.