Langford View is a nursing home run by The Orders of St John Care Trust. The home provides support and nursing care for up to 60 older adults. This includes support for people living with dementia.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good

At our previous inspection on 22 October 2015. We identified that the service did not always maintain accurate medicines administration records (MAR). This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the registered manager had made significant improvements to address our concerns. MAR were completed to show when medication had been given. People's medicines were managed safely and kept under regular review.

People told us that they felt safe. Staff were aware of how to safeguard people from harm and were aware of potential risks and signs of abuse. There were sufficient staff to meet people's needs

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 support this practice.

People's health care needs were taken care of and they had access to a range of healthcare professionals. Where required, appropriate referrals were made to external health professionals such as G.P’s or therapists. People told us they enjoyed the food provided by the home.

People and their relatives were very complimentary about the staff and management at the home. They told us staff were kind, caring and compassionate. Staff members, including the management team, were knowledgeable about individuals' care and support needs and preferences.

The provider had systems in place to receive feedback from people who used the service, their relatives, and staff members about the service provided. People were encouraged and supported to raise any concerns with staff or management and were confident they would be listened to and things would be addressed.

There was an open and inclusive culture in the home and people, their relatives and staff felt they could approach the management team and were comfortable to speak with the registered manager if they had a concern.

We inspected Langford View Care Centre on 22 October 2015. The inspection was unannounced.

Langford View Care Centre is a nursing home run by The Orders of St John Care Trust. The home provides support and nursing care for up to 60 older adults. This includes support for people living with dementia.

The home had a 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 2008 and associated Regulations about how the service is run.

At our last inspection in December 2014 we found medicines were not always administered and recorded safely. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations which corresponds with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection in October 2015 we found the provider had taken action to ensure medicines were administered safely. However, we have asked the service to continue making improvements to the recording of medicines. This was because an accurate record of people’s medicines and the administration of those medicines were not always kept.

People felt safe and supported by competent staff. Staff felt motivated and supported to improve the quality of care provided to people and benefitted from regular supervision and training in areas such as dementia awareness.

People were cared for in a caring and respectful way. People were supported to maintain their health and were referred for specialist advice as required. People were provided with person-centred care which encouraged choice and independence. Staff knew people well and understood their individual preferences. Risks to people’s health were identified and plans were in place to minimise the risks. Visiting professionals were complimentary about the level of care provided at the service.

People were supported to have their nutritional needs met. People liked the food, regular snacks and drinks were offered and mealtimes were relaxed and sociable. People who had lost weight had a plan in place to manage their weight loss. People were supported with specialist diets and nutritional supplements as prescribed.

People told us they enjoyed the many and varied activities. People who were living with dementia benefitted from an interesting and stimulating environment.

The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions or who may be deprived of their liberty for their own safety.

People, relatives, staff and visiting professionals were complimentary about the registered manager and the management team. The registered manager sought feedback from people and their relatives and was continually striving to improve the quality of the service. There was an open culture where people and staff were confident they could raise any concerns and these would be dealt with promptly.

We inspected Langford View Care Centre on 11 December 2014. The inspection was unannounced. The home was last inspected on 17 October 2013.

Langford View Care Centre is a nursing home run by The Order of St John Care Trust. The home provides support and nursing care for up to 60 older adults. This includes support for people living with dementia. At the time of our inspection there were 58 people living at the home.

The home had a 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 2008 and associated Regulations about how the service is run.

People’s medicines were not always administered and recorded safely. Staff administering medication did not always follow the provider’s policy.

Some people’s care records were left outside their room which meant their personal information was not kept confidential.

Quality assurance systems were not always effective as some care records contained information that was not up to date. Some audits had identified issues and action plans showed how these would be managed. Accidents and incidents were audited by the registered manager to identify trends and patterns.

There were sufficient numbers of staff to meet people’s needs and people were positive about the staff supporting them. Staff understood their responsibilities regarding safeguarding adults and felt confident to raise any concerns.

Throughout our visit the atmosphere was pleasant and relaxed. People were supported in a friendly, respectful manner. People were positive about living in the home and complementary about the staff. People were not rushed and staff took to time to sit and talk with them.

People were able to join in activities of their choice. People who preferred to spend time in their rooms had regular visits from staff. Staff knew people well and were able to talk to them about things that interested them.

People were supported by staff who were knowledgeable about their needs. Staff had access to training and development to ensure they had skills necessary to support the people living in the home. Staff felt well supported by the management in the home and told us morale in the home was good.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

At our last inspection on the 27 June 2013 we found non-compliance regarding staffing. The provider sent us an action plan on how they would address this non-compliance and we inspected again to check they had taken appropriate action. We saw that the provider had taken appropriate action to address the non-compliance.

On the day of our visit there were 54 people using the service. We spoke to five people who told us that they liked the home and that things had improved. One person said "they always need more staff but my bell gets answered promptly and they seem to have time to chat". Another said "they are lovely and work so hard. I do think things have got better lately, especially mealtimes".

We spoke with five care workers who told us things had improved. One said "I think there is enough staff now. I don't feel rushed and I believe we are supported to do our job". Another said "now we get help with mealtimes we get more time with the residents".

We looked at six care worker’s files and saw they had been recruited and selected appropriately. All the files contained Disclosure Barring Service (DBS) checks, references and proof of identity. We also saw that care workers received an induction training programme and a period of shadowing with a named mentor before being signed as competent.

Care workers were supported. We saw evidence that monthly 'staff meetings' were held. Supervisions were conducted, recorded and fed into annual appraisals.

At the time of our visit 51 people were living at the home. We spoke with nine people who used the service. They all said they liked living at the home and they spoke highly of the care workers. One person said "I like it here, I am well looked after". Another said "it is lovely, like a hotel and the food is excellent". 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 saw that inter-actions between care workers and people were mainly positive.

We spoke with five members of care/nursing staff who told us they felt supported and well trained. They all said they liked working at the home. One said "I have worked here since we opened. I love my job". Another said "It is lovely here". However, all the care workers we spoke said they felt there was not enough staff working at the home. One said "It has been getting a little better but the last couple of months have been terrible". Another said "If I am honest, no, there is not enough staff. Even when everyone turns up it is still very tight". We saw that care workers were rushed throughout the day and that call bells often took a long time to be answered.

People told us they felt safe and we saw that they were involved in their care. Care workers were attentive and respectful and we saw a good range of activities for people.

We spoke to four people and one relative during the visit. People told us that the move from the old home to the new had gone very smoothly.

People told us they were kept informed of progress through the project by means of regular news letters. People said that they had breakfast in their old home and dinner in the new. People liked the new home “ my bathroom is the best “ one person said, although at the time of the visit there was a design fault that meant the showers could not be used. This was being addressed and in the mean time people were having baths. People we spoke with told us “ every day there is something to do “ “ I have had my nails done today “. People also said that the food was good and that they were given a choice. One person said “ my nephew visited and he was very impressed “. Visitors were made welcome to the home and there were no set visiting times. There were rooms available on both floors for people to have visitors in private. On the day of the visit there was seven staff on duty for 31 residents.

During the visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences and staff interaction during this session was like.