Langholme is a care home which provides care and accommodation for up to 39 older people, some of whom are living with dementia. It is part of the MHA group, a Methodist charity and housing association providing a range of care services for older people On the day of the inspection there were 38 people using the service. We carried out this inspection on 8 March 2017. The service was last inspected in June 2015. At that time we were concerned the arrangements for the management of medicines were not robust and we found the service was in breach of the regulations.

The service is required to have a registered manager and at the time of our inspection 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 and associated Regulations about how the service is run.

The service was split into two units. People who were living with dementia lived in the ground floor unit. People who required residential care had their accommodation on the first floor unit. Each unit had a dining and lounge area and a small kitchen where drinks and light snacks could be prepared. A larger kitchen was used to prepare meals for both units.

People told us they were happy with the care they received and believed it was a safe environment. One person told us; “I tell them if I need anything at all.” A relative said; “My [relative] is well cared for. They are considerate and make allowances for people. They do what they can to assist.”

The service was consistently staffed in line with the staff numbers identified as necessary. Staff told us people’s needs were increasing and it was becoming more difficult to deliver care in line with people’s preferences with the staffing levels in place. We have made a recommendation about this in the report. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role.

New staff completed an induction before starting to work directly with people delivering personal care. Training was updated and refreshed regularly. Staff told us the training they received was good and equipped them to carry out their roles effectively. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

People received their medicines on time. Medicines administration records were accurate and consistently completed. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians.

People were assessed in line with the Mental Capacity Act (2005) where relevant and the management team followed the legislation to help ensure people’s human rights were protected. Best interest meetings were held when people had been assessed as not having capacity to make specific decisions. These involved other professional and family members to help make sure people’s voices were heard.

Care plans were up to date and relevant and staff told us they were a useful and accurate tool. Any risks in relation to people’s care and support were identified and integrated into the care plans. Risks specific to people’s individual health and social needs were identified. People had regular opportunities to contribute to their care plan with the support of their families if they wished.

An activity co-ordinator was employed to organise planned events. The care staff were supported by additional staff who worked with people to support their emotional and spiritual needs. People told us they were able to make day to day decisions about how and where they spent their time. Care plans and risk assessments recognised the need to support people to maintain their independence.

There was a management structure in the ser

We carried out a comprehensive inspection on 17 February 2015. A breach of the legal requirements was found. This was because the arrangements in place for the administration and management of medicines at the service were not robust. There were gaps in the medicine administration records (MAR) where staff had not signed to show they had given people their medicines at specific times of the day as prescribed. Handwritten entries on the MAR had not been signed by two people to help reduce the risk of errors. Prescribed creams were not recorded when applied by staff, and creams were not dated when opened. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focussed inspection on the 26 June 2015 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Langholme on our website at www.cqc.org.uk

Langholme is a care home for older people who are living with dementia. At the time of the focussed inspection on 26 June 2015 there were 36 people living at the service.

There was a registered manager 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.

At this focussed inspection we found the registered provider had addressed some of the concerns found at the last inspection, however there continued to be concern regarding people receiving prescribed creams as prescribed and these being recorded appropriately by staff.

At the beginning of June 2015 the service had begun to use a new method of administering and managing people’s medicines. The service now used a medicine dispensing system (MDS) which placed all prescribed medicines in pharmacy sealed blistered packs pre prepared with doses for each individual. This meant it was clear when prescribed medicines were due and helped ensure medicines would not be missed.

The medicines administration records (MAR) had been fully completed by staff when people had been given their medicines. There were no gaps on these records.

All handwritten entries, which had been entered on the MAR following advice and guidance from medical professionals, had been signed by two staff. This helped reduce the risk of errors.

Some people were prescribed topical medicines such as creams. The MAR was not signed by staff when the cream was applied. This meant is was not clear if people had their creams applied as prescribed. Creams were not dated upon opening, this meant staff were not aware of the period during which the cream was safe to use and when it should be discarded as expired.

One person had been prescribed a cream for a specific period of time after which the treatment should have been reviewed. The review had not taken place and the cream continued to be available in their room.

The action taken by the provider to address the concerns raised in the previous inspection had not been entirely effective. This service remains in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014

Langholme is a care home which provides care for up to 40 people. On the day of this inspection there were 37 people living at the service.

The registered manager for this service had retired recently. There was a new manager in post who was responsible for the day-to-day running of the home. This manager was in the process of applying to become the 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection on the 17 February 2015. We last inspected the home on the 9 October 2013. We had no concerns at that inspection.

We inspected the home over one day. The service comprised of two units. The ground floor unit supported people who were living with dementia. This unit had a large lounge/dining area with corridors running around the outside from which people’s bedrooms were accessed. The doors to people’s bedrooms and the rooms themselves were personalised. However the rest of the unit did not have any additional signage or prompts to help support the orientation of people to different parts of the unit. The first floor unit supported people who required residential care. Each unit had its own kitchenette which provided hot drinks and snacks for people throughout the day. There was a main kitchen in the service which provided main meals to both units.

We looked at the arrangements in place for the administration and recording of medicines at the home and found it was not safe. There were gaps on the medicine administration records (MAR) and two staff had not signed handwritten entries on the MAR to help reduce the risk of errors. Whilst there were quality assurance systems in place the medicines audit had not identified these concerns. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010, which corresponds to Regulation 12 (f) (g) of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see the action we told the provider to take at the back of the full version of this report.

Prior to this inspection we received information of concerns regarding staffing levels at the service. During this inspection people told us; “We do have to wait sometimes if they (staff) are busy,” “There is not enough staff on duty.” The service had been through a period of low staffing numbers due to short notice staff sickness absences occurring on a regular basis. The manager had taken steps to address these issues with individual staff and was in the process of appointing new staff. Healthcare professionals told us; “The communication in the home has improved dramatically recently, there is now much clearer leadership. They (care staff) always call me appropriately.”

Staff working at the home understood the needs of people they supported. Staff received training and support which enabled them to be effective in their care and support of people in the home. The new manager had been well supported during her induction. The service had robust recruitment processes in place to ensure new staff were safe to work with older people.

People were happy with the meals. They told us; “The meals are lovely” and “The food here is good.” One family told us whose relative chose to eat their meals in their own room told us “The food is often not as hot as it should be when it reaches (the person) it is a shame.” People could choose from a variety of activities at the service. People told us; “Keep fit and dancing is good” and “We go out in the garden in the sunshine, lovely garden.” There was a visiting chaplain who provided support and guidance for people, families and staff.

The service had good relationships with other external healthcare professionals who ensured effective care delivery for people whenever they needed or wanted it. Families and staff felt they could raise any concerns or issues they may have with the manager who was approachable. People felt their views and experiences were listened to.

We spoke with five people who lived at Langholme, their comments included “the food here is particularly good” and “the staff are very kind”. We also spoke with three members of staff, the registered manager, a visiting chaplain, visiting healthcare professionals and two visitors to Langholme.

We found people’s views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.

People’s privacy and dignity was respected and people experienced care, treatment and support that met their needs and protected their rights.

People were cared for in a clean, hygienic environment.

There were enough qualified, skilled and experienced staff to meet people’s needs

People were protected from the risks of unsafe or inappropriate care and treatment as records included appropriate information in relation to the care provided to people who used the service.

We spoke with four people who lived at Langholme to seek their views of the service that they received. People said the home was clean and tidy and the staff were generally kind and helpful. One person told us “some staff are better than others”. They then added “some of the staff are excellent and will do anything to help you they are lovely but some don’t seem to care as much”. Another person commented “the staff are kind, look after me well and I feel happy and safe here”.

Staff and people who used the service expressed concerns regarding the staffing levels in the home. We saw that staff were busy during our inspection and records showed that at times the planned and / or requested care had not been able to be delivered due to insufficient staff on duty.

The privacy and dignity of people who used the service was promoted and respected by the staff.

People were protected by the systems and procedures in place for the administration of medication.

The environment that people lived in was clean, tidy, comfortable and the control of infection promoted. People were complimentary about the home they lived in and positive comments were made about their bedrooms.

People said they were happy living in the home. People said that staff were hardworking and caring. Staff were also seen as attentive and said to respond promptly to individual needs. People said the food was good and there was enough to eat and drink. Everyone said they were happy with their accommodation. People said there were lots of opportunities to participate in activities in and outside the home.