Langdon House care home provides accommodation and care for up to 52 older people some of whom live with dementia. There were 48 people living at the home when we visited. Accommodation is provided over two floors and there are communal areas including lounge areas, bathrooms and dining areas. All bedrooms are single rooms. There is a communal garden area for people and their guests to use.

This unannounced inspection was carried out on 20 July 2017. At the last inspection on 21 April 2015 the service was rated ‘Good’. At this inspection we found the service remained good.

There was a registered manager in post. 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.

People told us that they felt safe living at the home. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any concerns. People received their medication as prescribed from staff who were appropriately trained.

There were sufficient numbers of suitably qualified staff employed at the home. The provider’s recruitment process ensured that only staff who had been deemed suitable to work with people at the home were employed.

Staff respected and maintained people’s privacy. People were provided with care and support as required and people had their care needs met in a timely. 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.

People’s care and support needs were assessed and planned by the registered manager and staff. The staff had an excellent understanding of how and when to provide people’s care whilst respecting their independence. Staff knew people well. Where possible people were involved in the reviews of their care plans. Care records were detailed and up to date so that staff were provided with guidelines to care and support people.

People were supported to access a range of health care professionals in a timely manner. Risk assessments were in place to ensure that people could be safely supported at all times.

People were provided with a varied menu and had a range of meals to choose from. There was a sufficient quantity of food and drinks and snacks made available to people.

Staff were proactive in arranging activities and they supported people with their hobbies and interests to prevent them from becoming socially isolated. There was a wide range of activities for people to be involved with.

The home had a complaints procedure available for people and their relatives to use and staff were aware of the procedure.

There was an open culture within the home and people were freely able to talk and raise any issues with the registered manager and staff team. People, staff and stakeholders were provided with several ways that they could comment on the quality of their care. This included regular contact with the provider, registered manager, staff and completing annual quality assurance surveys.

Langdon House is registered to provide accommodation and personal care for up to 52 adults some of whom are living with dementia. There were 49 people living at the home during our visit. The home has accommodation provided on two floors. Accommodation consists of single occupancy bedrooms with en-suite facilities. There are internal and external communal areas, including a kitchen, lounge/ dining areas and a garden for people and their visitors to use.

This unannounced inspection was carried out on 21 April 2015. At our previous inspection on 04 February 2014 the provider was meeting all of the regulations that we assessed.

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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. There were systems in place to assess people’s capacity for decision making. Appropriate applications were made to the authorising agencies to ensure that people’s rights were protected. Where people were assessed not to have mental capacity, their care was carried out in their best interest. This included the use of covert administration of medication and support with their daily care needs.

People who lived in the home were supported by staff in a caring and respectful way. People had individualised care and support plans in place which recorded their likes and dislikes, needs and wishes, including end of life wishes. These plans gave staff guidelines on any assistance a person may require.

Individual risks to people were identified by staff. Plans were put into place to minimise these risks to enable people to live as independent and safe a life as possible. There were arrangements in place for the management, administration and safe storage of people’s prescribed medication. People received their medication as prescribed.

Staff took time to reassure and engage with people who were becoming anxious in an understanding and patient manner. People and their relatives were able to raise any suggestions or concerns that they might have with staff and the management team and feel listened too.

People were supported to access a range of external health care professionals and were supported to maintain their health.

People were provided with adequate amounts of food and drink to meet their hydration and nutrition needs.

There were a sufficient number of staff employed to ensure that people were safe. Staff understood their responsibility to report poor care practice. Staff were trained to provide effective care which met people’s individual care and support needs. They were supported by the registered manager to maintain their skills through training. The standard of staff members’ work performance was reviewed by the management through supervision and appraisal to ensure that staff were competent.

The registered manager sought feedback from people who lived at the home by holding residents and relatives meetings. There was an on-going quality monitoring process in place to identify areas of improvement required within the home. Where improvements had been identified there were actions plans in place which documented the action taken or to be taken.

As the main purpose of this inspection was to assess improvements made in relation to shortfalls identified during our previous inspection on 4 November 2013, we did not request information directly from people using the service.

During this visit we found that the provider had taken good action to address shortfalls in relation to complaints recording and management, and that people could be assured their concerns were dealt with appropriately.

People’s rights to give consent to their support and care were respected. Where a person was not able to give this consent, there were legal systems in place to ensure that the person received support, care and medical treatment that they needed.

People who used the service were supported to maintain their health and wellbeing. This included support to access health care professionals; to engage in recreational activities of their choosing; support to maintain contact with the local community and with their friends and family members.

People were provided with adequate amounts of food and drink to ensure they were kept healthy. People were also provided with opportunities to choose what they would like to eat and drink.

There were systems in place to make sure that people were protected from the use of unsafe equipment.

Staff were trained and supervised to provide people with safe and appropriate care. There were arrangements in place to ensure that all members of staff had attended health and safety training by no later than 01 January 2014.

There was a complaints procedure in place but improvements are needed to effectively respond to people’s concerns.

During our inspection on 10 December 2012, we spoke with 12 people who lived in the home. They all said that they were involved in the planning of their care. They also told us they were asked their views about the care provided at their meetings and staff were always asking them. One person told us, "It’s a wonderful place we are well looked after". They all told us they felt safe and would raise any concerns with the manager.

We observed staff supporting people in a kind and calm manner. Communication was positive and staff spoke respectfully with people. Staff were provided with appropriate training to enable them to meet the needs of the people who lived in the home.

The organisation had systems in place to monitor the quality of the service provided and action was taken to address any issues that were highlighted as needing improvement.

This review was undertaken to assess improvements made in relation to shortfalls identified during our previous review of compliance in December 2011, these shortfalls related to care plans, hygiene, medication administration and staff training. We did not request information directly from people using the service on this occasion. However, during our previous visit we spoke to people who told us that both the quality of care they received and the home’s staff were good.

Many people commented on the atmosphere of the home. A visiting chiropodist reported, “There’s a good feel to this home” and one relative stated, “There’s a good atmosphere as soon as you walk in the door”. Another person reported, “It’s a happy and caring establishment”.

We received many positive comments about the home’s staff in particular. One person told us, “There’s not one member of staff I don’t like” and another person stated, “Staff are very respectful, attentive and smiling”. One relative commented, “Dad really is very fond of the staff and it’s clear they like him”. However, a few people mentioned the high use of agency staff recently and although they stated they were good, also commented that these staff didn’t know them as well as the regular staff.

One person, who was a vegetarian, told us that the home catered for him well and he was offered a varied and tasty selection of food.

We spoke with a GP, a visiting chiropodist and a district nurse all of whom reported that staff knew the needs of people well and none had any concerns about the quality of care provided there.

Relatives told us that staff at the home always made them feel welcome and were good at keeping them informed of what was happening with their family members: two in particular valued the regular email contact they received from staff. One relative stated, “Whenever I have a question about my aunt, the staff always have, or are able to find out, the answer quickly.” However, one relative was disappointed that their written complaint about not being able to alert night staff to open the door for them when returning late at night from the hospital with their father, was not responded to.