This unannounced inspection took place on 20 September 2018. This is the second comprehensive inspection of this service. At the previous inspection the service was rated as good. At this inspection the overall rating for the service remained Good. However, the rating for ‘is the service safe’ had deteriorated to requires improvement.

Langley Lodge Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 18 people using the service. Langley Lodge Residential Home can accommodate up to 20 people in individual or double bedrooms in one adapted building. It is a two-storey building with a stair lift to access the first floor.

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.

The service was not always safe. Medicines were not always administered as prescribed and the recording of some medicines was not accurate. Healthcare professional advice had not always been sought when errors occurred. Incidents of potential neglect had not been referred to the local safeguarding authority. Risks to people were identified but they were not always well managed. This put people’s safety at risk.

We have made a recommendation about the management of some medicines.

Sufficient staff were in post and the recruitment process for new staff had helped ensure that only suitable staff were employed. Lessons were learned when things had not always gone well. Staff adhered to the provider’s policies in maintaining a clean environment.

The service was effective. People’s needs were met by staff who had the right training and skills to do this. People at healthily and they had sufficient quantities of food and drink. People were enabled to access health care services. 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. The registered manager worked with others involved in people’s care, such as health professionals when people moved into the service so they received consistent care.

The service was caring. People received compassionate care from staff who took account of each person’s care needs. People’s privacy and dignity was promoted and respected. People were given support and information to access advocacy services. Staff involved people in their care with care and consideration of how they wanted to be cared for. People were cared for without discrimination. People’s confidential records were held securely.

The service was responsive. People received person centred care that was based upon their what their preferences were. People could be as independent as they wanted to be. Technology was used to enhance the quality of people’s lives. People concerns were identified and responded to and this helped drive improvement. People, relatives and staff, when required, had the support they needed if any person needed end of life care.

The service was well-led. The registered manager led by example and ensured the staff they supported had the right skills and values. Staff worked as a team to help people and each other. Quality assurance and governance systems were mostly effective in identifying and acting upon improvements when these were needed. People had a say in how the service was run. Staff were given feedback and support with their work in a positive way. An open and honest staff team culture was in place. The registered manager and staf

Langley Lodge Residential Home is registered to provide accommodation for up to 20 people who require nursing and personal care. At the time of our inspection there were 20 people living at the service. The service is located in the town of Wisbech close to local shops, amenities and facilities. The service is a two storey building with access to the first floor via stairs or a stair lift for people whose mobility requires this. Bathing and shower facilities are available for people if they preferred either option.

This unannounced inspection took place on 3 March 2016.

The service had a registered manager. 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.

Staff had been trained on how to protect people from harm. They were knowledgeable about applying this information and were confident in recognising potential signs of harm. People's individual care needs were met by a sufficient number of suitably qualified staff. Only staff whose suitability to work with people living at the service had been ensured were offered employment. The provider had systems in place to assess and manage risks to people’s safety.

People's medicines were managed and administered in a safe way. People who required their medicines to be administered in a particular way were supported to take their medicines as prescribed. An effective induction process was in place to support new staff. Staff were provided with training which was kept up-to-date according to their role. People were supported and cared for in a safe way based upon the risk assessments which had been completed and regularly updated.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered and deputy manager were knowledgeable about when an assessment of people’s mental capacity was required. Appropriate applications were in progress to lawfully deprive some people of their liberty. However, not all staff had an understanding of the MCA and how a DoLS would be determined. This meant that there was a risk that people could be provided with care that was not in line with the MCA and DoLS code of practice.

People were given choices of their preferred food and drink options. This included a choice of appropriate diets for those people at an increased risk of malnutrition, dehydration or weight loss. People were supported to access a range of health care services and staff were prompt in identifying people's health needs.

People's care was provided with compassion by staff who showed genuine concern for people's wellbeing. They, and their relatives, were involved in the review of people’s individual care plans. People’s privacy and dignity was respected by staff who were skilled in respecting people's privacy.

People were provided with information on accessing independent advocacy services if any person required this support.

People were given various opportunities to help identify and make key changes or suggestions about any aspects of their care. Some opportunities were missed to support people with their care needs which could benefit their uptake of hobbies, interest and social stimulation.

A range of effective audit and quality assurance procedures were in place and these were used to help drive improvement. Information regarding the running of the service and people’s care was shared through a range of forums including residents’, managers’ and staff meetings.

People’s right to give their consent was valued. However the systems used to assess people’s mental capacity to make valid decisions about their care and support, should be improved.

All of the people who we spoke with were satisfied with the quality and standard of their support and care. Assessments of people’s risks and health and social care needs were carried out and planned. People received their support and care as planned.

Arrangements were in place to ensure that people who used the service had access to safe equipment.

Staff were supported to do their job, which they said was rewarding. There were arrangements in place for staff to attend training relevant to their role.

People had access to up-to-date information about the services provided at Langley Lodge Residential Home.

There was a system in place which allowed people to make their concerns and complaints known. People who we spoke with said that they knew who to speak with if they were unhappy about something and were satisfied with the response that they received.

Although we did not speak to any person about this standard, we found that they had access to improved hand washing and drying facilities in their bedrooms and communal toilet and bathing facilities.

We found that that remedial action was taken to minimise people's health risks associated with acquired infections. This included improved cleaning systems of bathing equipment and the removal of communal creams and toiletries.

There were some improvements in staff training and instruction regarding cleaning products and management, and control of infection. However, more formal infection control training had not been made available. This is an area where improvements could be made to ensure that staff had up-to-date knowledge to provide people with continued safe and appropriate care.

The infection control policy remained out-of-date and was not revised by the timescale set by the provider for completion. We were advised that this delay was due to other priorities that had taken place. The manager advised us that the revised infection control policy would be made available by 21 September 2012.

People who we spoke with were satisfied with how their support and care needs were met. They were complimentary about how staff treated them. They said that they were treated with respect and were actively involved in making decisions about their day-to-day support and care.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We noted that people's wellbeing was promoted due to effective ways staff engaged with them. This included telling people stories about their families and sharing a joke with them.

One person told us that they, "Could not have wanted anything more" because they liked living at the home. Other people were satisfied with how they were looked after. This included having opportunities provided to take part in social activities.

We were told that people felt, "Safe" because staff treated them well. One person told us that they could not have wanted anything more because they liked living at the home.

People said they liked their rooms, especially looking out of their windows at the views of the garden and activities taking place on the road outside.

People also said that their support and care needs were met by staff who were skilled and knowledgeable to safely to dot heir job. People said that there was a sufficient number of care staff on duty so that they did not have to wait for assistance.

People we spoke with during our visit on 13 January 2012 told us they were satisfied with their care and made positive comments about staff. One comment made was, "The staff are always there when I need them and respond to my call alarm in time".

People informed us they felt safe living at Langley Lodge and that staff treated them with respect. People told us they would raise any concern with the manager whom they said they had daily contact with.