This unannounced inspection took place on 12&14 December 2016. We last inspected this service on 6 June 2016 under the regulations that were in force at that time. This was a focussed inspection undertaken to check that improvements that needed to be made to meet legal requirements after our comprehensive inspection in October 2015 where concerns were identified. We found that the provider met the regulations we inspected at that time.

Langrigg House is registered to provide care and accommodation for up to 40 older people, some of whom may be living with dementia. There were 29 people living in the home on the day of our inspection visit.

There were two registered managers in post on the day of our inspection.

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 who used this service were safe. The staff knew how to identify if a person was at risk of abuse and the action to take to protect people from harm. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified.

Staff had completed training in the protection of vulnerable adults and we were told us that this was also discussed in supervision and staff meetings. The registered managers and the staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff had been recruited following a thorough recruitment process and they were clear about their responsibility to promptly report any concerns or safeguarding issues. Staff were well trained in subjects appropriate to their roles in the staff team.

People had access to external health care services which ensured their health care needs were met. These included GPs, district nurses, dentist and opticians. Staff had completed training in safe handling of medicines and the medicines administration records were up to date. Protocols were in place for the receipt and disposal of all medicines that came into the home.

People were provided with sufficient food and drink in order to maintain good levels of nutrition and hydration. We saw that drinks and snacks were available throughout the day.

We saw that people were treated with kindness and respect. They were included in planning and agreeing to the support they received. The care staff knew the people they were supporting well and respected the choices they made about their care. The staff knew how people communicated and gave them support to make and express choices about their lives. People were encouraged to follow activities of their choice both in the home and out in the wider community if they wished.

The registered managers set high standards and the focus of the service was on promoting people’s choices and rights. The registered managers and the staff team had a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, (DoLS). They understood how to protect the rights of people who needed support to make important decisions about their lives.

The provider had systems in place to deal with any concerns or complaints. There had been no complaints to record.

There was an appropriate internal quality audit system in place to monitor the quality of the service provided.

Langrigg house was managed by two registered managers who were experienced and qualified to run the service. Staff felt well supported by the registered managers who promoted strong values and a person centred culture.

We undertook an unannounced focused inspection of this service on 6 June 2016. This inspection was undertaken to check that improvements that needed to be made to meet legal requirements after our comprehensive inspection in October 2015 where concerns were identified.

We had carried out an unannounced comprehensive inspection of this service on between 21 and 23 October 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to the breach contained in the comprehensive inspection. This report only covers our findings in relation to those requirements and recommendations.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

The inspection was carried out by the lead adult social care inspector.

Langrigg House is a residential home located in the West of Carlisle and is close to all the local amenities and services. The home has five units, On the ground floor there is a unit that provides care and support for people living with dementia and a respite unit. On the first floor there are three units providing care and support to frail and elderly people, these three units are not physically separated but each have their own seating and food preparation areas.

The service had 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 and associated Regulations about how the service is run.

People living in Langrigg House told us they “felt safe and happy”. Relatives said they were pleased with the support received and caring attitude of all the staff.

People were protected by staff who knew how to keep them safe and managed individual risks well. Staffing levels were appropriate during the day and night to meet the needs of those using the service and to promote their independence.

During the previous inspection the storage of medicines gave cause for concern as they were not stored securely. Medicines were now stored safely in locked cupboards and administered according to people’s needs.

The registered manager provided details of the staff training that evidenced this had improved since the last inspection. Staff confirmed they received training appropriate to their roles within the staff team. Further specialised training in the care of people living with dementia was being planned to start in July 2016.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. We recommended that the training in the MCA being organised by the provider be completed by all the care staff as soon as possible.

People were provided with sufficient food and drink in order to maintain good levels of nutrition and hydration. People told us “We have a choice of meals and if there is anything we don’t like we can choose something else and the cook provides it” and “The food is excellent and all home cooked”.

People had access to external health care services which ensured their health care needs were met.

Improvements to the environment were on-going and were providing a safer place for people to live in.

The home had an experience and suitably qualified registered manager in place and staff told us they fell well supported by the registered manager.

People knew how they could complain about the service they received and information about this was displayed in the home. People we spoke to were confident that action would be taken in response to any concerns they

This unannounced inspection took place on 21, 22, 23 October 2015. We last inspected Langrigg House in November 2013. At that inspection we found the service was meeting the five regulations that we assessed.

Langrigg House is a residential home located in the West of Carlisle and is close to all the local amenities and services. The home has five units, On the ground floor there is a unit that provides care and support for people living with dementia and a respite unit. On the first floor there are three units providing care and support to frail and elderly people, these three units are not physically separated but each have there own seating and food preparation areas.

The service had 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 and associated Regulations about how the service is run.

We found at this inspection that there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not sufficient numbers of support staff at night time to meet the assessed needs of people living in the home and in emergency situations. Furthermore staff had not received sufficient appropriate training to support people who lived with dementia.

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

We made the following recommendations:

We recommended that the service review the way they stored medicines.

We recommended that the service review its schedule of works with a view to completing renovations in a timely manner.

We recommended that the provider review their best interest decision making process to ensure it followed guidanceoutlined in the Mental Capacity Act 2005.

We recommended that the provider responded to issues highlighted by their registered manager and their quality assurance system in a timely manner.

People who used the service told us that they felt safe. Staff knew how to identify and report abuse.

The service had safe systems for the recruitment of staff to make sure the staff taken on were suited to working there. However the registered manager and the staff told us that recruitment took some time.

People’s nutritional needs were identified through assessment. Kitchen staff and care staff knew how to meet people’s nutritional needs. The manager had responded to a concern raised about the menus and was improving them.

People told us that staff were caring and spoke to them in a respectful way.

People knew how they could complain about the service. People we spoke with were confident that action would be taken in response to any concerns they raised.

The registered manager in the home supported staff. She had identified issues that we highlighted and alerted the provider.