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Inspection on 19/01/10 for Langdale Residential Home

Also see our care home review for Langdale Residential Home for more information

This inspection was carried out on 19th January 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staffing numbers were sufficient to meet the needs of people living at Langdale House and staff had received the training they required to do their jobs. Staff spoken with were professional and motivated towards improvement. Staff said they felt supported. Interactions observed between residents and staff were positive and respectful. The atmosphere was calm and the service had a homely feel. people living at Langdale House appeared relaxed and well cared for. One person told us that all the staff were excellent. It was evident that the providers regularly engaged with people living at Langdale House and made every effort to meet their needs or address their concerns.

What has improved since the last inspection?

Since the last inspection the providers had recruited a manager who was due to commence her role shortly after this inspection, there has been a long absence of a registered manager at the home and a period of a consistent clear sense of leadership is required. The providers have considered their future plans for Langdale House and have decided that because of the specialist needs of people living there, it will be necessary to restrict the numbers of people living there from 27 to 22, this will be a voluntary restriction which the providers will include in their Statement of Purpose. The purpose of this restriction is to ensure that the environment can meet the specialist needs of people accommodated. The providers are considering using some bedroom accommodation for communal or therapeutic purposes.

What the care home could do better:

Care plans and opportunities for social and recreational activities did not always take into account peoples individual needs and preferences. Staff had gathered information about peoples life history and personal preferences but this had not always been Incorporated into peoples care plans which meant they did not always receive the care they would prefer. This is of particular importance for people who may have communication difficulties and may not always be able to make their wishes known. While there was a range of social and recreational activities on offer, they did not always meet individual needs and preferences and did not provide meaningful activity for some people. Meaningful activity is important for a sense well being and fulfillment. Care plans for the management of challenging behaviour were not sufficient to meet peoples needs or to keep them safe and some examples of patronizing and judgmental language were seen within care records. it is important that people are treated with dignity and respect at all times and that staff have a good understanding of why people may behave in a challenging way rather than only addressing the behaviour.

Key inspection report Care homes for older people Name: Address: Langdale Residential Home 6 Church Street Sapcote Leicestershire LE9 4FG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Debbie Williams     Date: 1 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Langdale Residential Home 6 Church Street Sapcote Leicestershire LE9 4FG 01455274544 F/P01455274544 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Neemat Kassam,Mrs Yasmin Nazir Kassam care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: No person in category PD(E) to be admitted to the home when there are 7 persons of that category already accommodated within the home. No person to be admitted to the home in categories MD(E) or DE(E) when 5 persons in total of these categories/combined categories are already accommodated in the home. Date of last inspection Brief description of the care home Langdale Residential Home offers accommodation for 27 Older Persons, and is situated close to the centre of Sapcote, which offers local shops including a Post Office and local supermarket. Views from part of the home overlook the local Church and countryside. Langdale Residential Home offers two lounges and one dining area to the ground floor, Care Homes for Older People Page 4 of 26 Over 65 5 5 27 7 0 0 0 0 2 7 1 0 2 0 0 9 Brief description of the care home with bedrooms being sited on the ground and first floor. Access to the first floor is via stairs, which has a chair lift and a passenger lift. The majority of bedrooms have ensuite facilities, which consist of a wash hand basin and toilet. Bathroom and showering facilities are located on both floors. A copy of the last inspection report was available at the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service on the 19th of January 2010 to carry out this key inspection. We case tracked four people living at the home and looked at their care records, spoke with staff about there care needs and observed care practices. We also looked at staff training records and spoke with staff about the training they had received. We looked at the providers Annual Quality Assurance Assessment (aqaa), this gave us information about what has happened at the service since the last key inspection. At the time of this inspection the provider had engaged a management consultant to run the home. Social services had suspended all placements at the service, this means that no new admissions could be made at the home until satisfactory improvements had been made. There were only eight residents living at the home at the time of this inspection. A new manager had recently been recruited and was due to commence employment at the home shortly after this inspection. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Care plans and opportunities for social and recreational activities did not always take into account peoples individual needs and preferences. Staff had gathered information about peoples life history and personal preferences but this had not always been Incorporated into peoples care plans which meant they did not always receive the care they would prefer. This is of particular importance for people who may have communication difficulties and may not always be able to make their wishes known. While there was a range of social and recreational activities on offer, they did not always meet individual needs and preferences and did not provide meaningful activity for some people. Meaningful activity is important for a sense well being and fulfillment. Care plans for the management of challenging behaviour were not sufficient to meet peoples needs or to keep them safe and some examples of patronizing and judgmental language were seen within care records. it is important that people are treated with dignity and respect at all times and that staff have a good understanding of why people may behave in a challenging way rather than only addressing the behaviour. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to make an informed choice about moving into the home. Evidence: The providers have a statement of purpose and service users guide and this is provided to all prospective residents. At the time of this inspection there was a formal suspension of placements due to previous safeguarding concerns at the home. This means that the providers are only able to provide accommodation for up to ten people while ongoing improvements are implemented and consolidated. Therefore, assessment of this outcome area was limited as no new residents had moved into the home for some time. We discussed the providers future plans for Langdale House and the providers agreed to restrict the numbers of people that can be accommodated at Langdale House to 22 once the formal suspension of placements was lifted, this is a voluntary restriction and Care Homes for Older People Page 11 of 26 Evidence: will be written into the providers updated statement of purpose. Because the service is registered to accommodate people with mental health needs and dementia, the providers are considering using some existing bedrooms as extra communal space and for therapeutic purposes. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Langdale House, mostly, have their health and personal care needs met. Care planning and medication practices need improvement in order to ensure that people experience care that meets their expectations and preferences. Evidence: We looked at care plans for four people we case tracked. Care plans were detailed and addressed all assessed needs, staff had made efforts to ensure that care plans were focused on the persons individual needs and preferences. Information was collected about peoples social and life history, likes and dislikes, however, this information was not always incorporated within the care plans and this meant that people did not always receive care that met their individual preferences. One persons care plan for the management of challenging behaviour was not sufficient and did not provide staff with clear instruction on how to manage verbal and physical aggression or how to keep people safe. Some of the language used by staff in care plans and daily records was judgmental and patronizing. Care Homes for Older People Page 13 of 26 Evidence: Evidence was seen of people having good access to health care professionals such as GPs, dentists, community nurses and dietitians. Risk assessments were completed for all identified risks and referrals were made to the appropriate health care professional and preventative action was taken. Daily records were maintained and these provided detailed information about daily events and of peoples wellbeing or otherwise. We observed interactions between staff and residents,interactions were positive and respectful. One person spoken with said that all the staff were excellent. We looked at policies, procedures and storage arrangements for the management of medicines. only two of the staff employed were responsible for the management of medication, both had received training and been assessed as competent for the management of medication. Medication administration records seen appeared accurate and up to date. We made a requirement that staff who are trained to manage medication are on duty at all times, this is to ensure that people living at Langdale House have access to their prescribed medication at all times. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are mostly able to exercise choice and autonomy about their daily lives. While a range of activities are on offer, they were not always meaningful to the individual. Evidence: Information was collected about peoples social and life history, likes and dislikes, however, this information was not always incorporated within the care plans and this meant that people did not always receive care that met their individual preferences. A range of social activities were being provided and these included going out of the home to the shop or to the pub and one to one activities such as doing jigsaws. Again information gathered about peoples individual likes/dislikes and preferences was not being Incorporated into social activity care plans. It is important that social and recreational activities are tailored to meet individual needs and preferences as this facilitates communication for people who have cognitive disabilities and provides meaningful activity,engagement and a more fulfilled lifestyle. People spoken with said they could choose how to spend their day and that daily routines were made flexible to meet their needs. We saw evidence of this during this inspection, people were offered their lunchtime meal at a later time to meet their individual need. We observed the lunchtime meal during this inspection and this Care Homes for Older People Page 15 of 26 Evidence: appeared appetizing and nutritious. A choice of meal is always offered and people can have a drink or snack at anytime. The cook has a record of peoples food likes and dislikes.Information regarding special diets required by people living at Langdale House were available for staff. We recommended that advice is sought regarding the nutritional needs of older people and that this is used to plan the weekly menu. There were no restrictions on people visiting the home and people could see their visitors in private. People told us that their visitors were made welcome and usually offered a cup of tea. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Langdale House were protected by complaints and safeguarding policies, procedure and practice. Evidence: There was a complaints procedure which is provided to all prospective residents and their relatives and is also available at the home. People spoken with felt they could speak with staff and to the provider about any issue and that their concerns would be taken seriously. Staff had received training regarding complaints and safeguarding procedures and were able to demonstrate a good awareness of safeguarding policies and procedures. Staff had received training in the management of challenging behaviour. A care plan for one person who displayed some physical and verbally challenging behaviour was not sufficient to address this behaviour in a safe way, we made requirement regarding this. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well maintained, homely and comfortable environment was provided. Evidence: All areas of the home seen were clean and tidy. Peoples own rooms were personalized, homely and suitable for their needs. At the time of this inspection there were eight residents living at the home, all but one were living in ground floor accommodation. There was one communal lounge and a separate dining area on the ground floor. The environment was well maintained, comfortable and homely. We discussed the providers future plans for Langdale House and the providers agreed to restrict the numbers of people that can be accommodated at langdale House to 22 once the formal suspension of placements was lifted, this is a voluntary restriction and will be written into the providers updated statement of purpose. Because the service is registered to accommodate people with mental health needs and dementia, the providers are considering using some existing bedrooms as extra communal space and for therapeutic purposes. One person we spoke with us told us that they had asked for a specialist bed and that this had been provided promptly. Staff had received training in infection control and this minimized the risk of cross Care Homes for Older People Page 18 of 26 Evidence: infection for people living at Langdale House. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Langdale House are cared for by competent staff who are deployed in sufficient numbers. recruitment procedures protect people from harm. Evidence: At the time of this inspection staff were deployed in sufficient numbers to meet the needs of people living at Langdale House. Staff employed had received induction training and all mandatory training such as moving and handling. There was an ongoing staff training programme and this included National Vocational Qualifications and training to meet the specialist needs of people living at Langdale House such as dementia care training. People spoken with told us the staff were good at their jobs and did not keep them waiting for attendance. We looked at recruitment files and found them to contain all relevant checks and references, this is to ensure that people working at Langdale House are suitable to do so and to keep peoples safe. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At the time of this inspection people were protected by administration and management procedures. However, a consistent and clear sense of management and leadership had not yet been established. Evidence: At the time of this inspection the registered managers post was vacant and the service was being managed by the registered provider and by a management consultant. A manager had recently been recruited and was due to commence employment shortly after this inspection. We discussed the providers future plans for Langdale House and the providers agreed to restrict the numbers of people that can be accommodated at langdale House to 22, this is a voluntary restriction and will be written into the providers updated statement of purpose. Because the service is registered to accommodate people with mental health needs and dementia, the providers are considering using some existing bedrooms as extra communal space and for therapeutic purposes. Care Homes for Older People Page 21 of 26 Evidence: A programme of quality assurance and audit was in place and this included seeking the views of people who used the service. Policies and procedures for the management of peoples personal money minimized the risk of financial abuse for people living at Langdale House. Staff had received all mandatory health and safety training. The providers told us in their annual quality assessment that all routine safety checks and maintenance work had been carried out, this is to ensure that people working and living at Langdale House were safe. Records were maintained of all accidents and incidents and these were also reported to the relevant authorities. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 31 8 A suitable person must be appointed to manage the service. This is to ensure the service is run in the best interests of people living there. 24/12/2009 Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Peoples individual care plans 05/03/2010 must be person focused and include peoples individual needs and preferences. This is so that people receive care that meets their expectaions and preferences. 2 7 14 Care plans must provide clear instruction to staff in the action they must take to meet peoples needs and to keep them safe. In particular, staff must know how to react to aggressive behaviour in a safe way. This is to ensure that people have their needs met and are protected from harm. 05/03/2010 3 9 13 There must be staff who are 25/03/2010 trained to administer and manage medication on duty at all times, including during the night. Care Homes for Older People Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that people living at Langdale House have are able to have the prescirbed medication they require at all times. 4 10 12 Staff must not use patronizing or judgmental language when referring to peoples needs or behaviour. This is to ensure that people living at Langdale house are treated with respect and dignity. 5 13 12 Information gathered about 26/03/2010 peoples likes dislikes and preferences must be Incorporated into their social and recreational care plan. This is to ensure that people are given opportunities to participate in activities that are meaningful to them. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 05/03/2010 1 15 It is recommended that further advice is sought regarding the nutritional needs of people living at Langdale House and that this be Incorporated within the menu provided. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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