Langley View Residential Home

Safe – This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement.

Requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. The registered manager told us they shared any learning from accidents and incidents with staff to consider what they could have done differently to help reduce the risk of a reoccurrence. However, no recent accidents/incidents or events had been recorded in the past 18 months This meant that there were no reflections or learning when things went wrong.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. The registered manager told us they shared any learning from accidents and incidents with staff to consider what they could have done differently to help reduce the risk of a reoccurrence. However, no recent accidents/incidents or events had been recorded in the past 18 months This meant that there were no reflections or learning when things went wrong.

The provider made sure there was continuity of care, including when people moved between different services. People were supported to transition through services, helping to ensure continuity of care. For example, people who lived at Langley View had been supported to move following an assessment at their previous home. The service worked in partnership with other care professionals and partners including the local authority, GP’s, opticians, pharmacies and occupational therapists to support people’s holistic needs. People had a health passport to take to health and hospital appointments. They contained relevant information relating to people’s health care needs and pathways.

The provider did not always work with people to understand and manage risks. Staff did not always provide care that was safe and enabled people to do things they liked doing. Risks were not always managed effectively. The registered manager told us certain cupboards were kept locked to ensure peoples safety. This included two kitchen cupboards that housed dangerous items.

During an evening visit we observed a Control of Substances Hazardous to Health (COSHH) cupboard in the kitchen was found unlocked. Inside the cupboard were various substances likely to cause harm if ingested, or if it came into contact with skin or eyes. At the same time, we observed another cupboard was found to be unlocked which contained a large amount of carving knives and other sharp kitchen utensils likely to cause serious harm if they got into the wrong hands. People living in the service were placed at risk of harm due to inconsistent approaches to managing safety. Staff did not work closely with individuals to understand and respond to known risks, it limited their ability to provide safe, enabling care. Following the visit staff were reminded about the importance of ensuring the cupboards are kept always locked when not in use.

People were given information to help them make appropriate choices about what the risks were and how to minimise them to help keep themselves safe. For example, people who went out to events or participating in activities in the home had a full and robust risk assessment completed. This helped reduce the risk of harm to both the person using the service and staff members.

People were not consistently protected from harm and or abuse, placing them at risk of unsafe or inappropriate care. We observed during an evening visit to the service that one service user pushed another from one side of the living room to the other causing the person to fall backwards into the settee. The person was not injured but had they have fallen to the floor they may well have sustained an injury. Staff intervened quickly but by then the person being pushed had come to rest on the settee. The registered manager told us; this was a one-off occurrence as the person was frustrated that a planned game had been delayed. The registered manager told us that the inspection visit had interrupted a planned card game which triggered agitation for one person resulting in them pushing another person. Staff will work with the person to identify triggers for them and develop a suitable plan with distraction techniques, to reduce the risk of a reoccurrence.

At the previous inspection people's capacity was not always assessed, and this meant their liberty may have been compromised. During the current inspection we saw that people had mental capacity assessments completed to determine if they needed support to help make important decisions. This ensured people's rights were protected, and they were not deprived of their liberty. Information was shared with other professionals only on a need-to-know basis.

Staff were able to describe different types of abuse and what they would do if they suspected any abuse. They had regular knowledge checks and staff completed safeguarding refresher training annually. Staff and management knew when they needed to make a referral and notify relevant partners including the local authority and the Care Quality Commission (CQC).

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. For example, the environment was not well maintained in relation to décor and flooring which was soiled in places. There was a risk of infection due to a lack of visible hand washing facilities. People had individual risk assessments completed. This was usually completed prior to people moving into Langley View. Risks were assessed in relation to the environment to help keep people safe.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide care that met people’s individual needs.

People received care from a staff team that had been recruited using a safe recruitment process, to ensure their suitability for the role. Staff confirmed the recruitment process was thorough. All staff had a disclosure and barring check [DBS] completed. This is a background check that employers use to verify an applicant's criminal history. References were taken up from previous employers. All staff completed an induction which covered all mandatory training including moving and handling, the safe administration of medicines, safeguarding people and infection control. Staff were required to attend regular training updates.

Most staff had completed specialist Oliver McGowan training. Two staff who had not yet completed the training were booked to complete the training. The registered manager was addressing this post assessment.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. For example, the cleanliness of the toilets and surrounding areas were visibly dirty. Food was left uncovered in the fridge which was not dated. Staff had completed infection prevention and control training However, as the risk was not effectively managed and refresher training was recommended. Staff were provided with personal protective equipment including gloves, aprons, hand sanitizer and face masks where required. In the kitchen we observed different coloured chopping boards for use with different food types. This practice promotes good food hygiene practices and helps prevent cross-contamination.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were supported to take their medication by staff who had completed training in the safe administration of medicines, to ensure medicines were managed and given safely.  Staff had competency checks completed and regular observations where they were shadowed when administering medication. Staff were aware of how to report any medication errors. Medication administration records were completed at the time of administering the medication and records were completed. The registered manager completed regular audits of medicines that showed people received their medication regularly. The registered manager told us that no one at the service were prescribed any medication for mood and or agitation.  People had regular medication reviews to help ensure they were not being over medicated or taking medication, they no longer required. [STOMP]. Stop over medicating people.

Effective – this means we looked for evidence that people’s care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People had their needs fully assessed, where possible prior to them moving into Langley View. This was to make sure it was the right environment for them to move into. The information from the assessment was used to inform the care plan in relation to what support they required. The assessment considered people’s physical and mental health as well as any sensory and or communication needs. People were involved as much as possible in determining how and when they wanted to be supported. Staff supported people to help maintain their independence, for example, when supporting people with their personal care, people were encouraged to manage as much of their own personal care as they were able. People’s care was kept under regular review to ensure the care continued to meet their needs.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked in line with the principles of evidence-based good practice. This included working in partnership with other professionals to provide holistic care and support to people. Staff had completed specialist Oliver McGowan training to help ensure they have a good understanding of the needs of autistic people and people with a learning disability. Health care decisions were made based on combining the best available scientific and clinical information and considering people’s individual values and preferences. Peoples care was monitored to ensure it was still relevant to their needs.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff worked in partnership with health and social care professionals to help ensure people received seamless care. When people were receiving support from other professionals, for example, occupational therapists or physiotherapists, there was clear guidance in place to ensure staff were aware of their roles and responsibilities. Staff communicated effectively with other services. Staff demonstrated they worked well as a team to deliver safe and effective care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. People were encouraged to keep healthy for example to remain as mobile and active as they could and to choose healthy food options. People were supported to make their own shopping list and go to the shops supported by staff. Where possible people were encouraged to help with the preparation of meals for themselves or for all people living there. People could choose what they wanted to eat, and snacks were readily available. People were encouraged and supported to participate in hobbies or things they enjoyed doing.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. People were supported to work towards achieving goals. This included assisting people to do as much for themselves as opposed to doing tasks for them. For example, supporting people to do their own personal care. This helped people remain independent. People were supported to attend health care appointments regularly. This included sight and hearing checks as well as dental check-ups to help maintain their wellbeing.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. People were asked to sign their care plan if they were able to give consent to their care. Those people who were unable to sign consent had an explanation on the consent form for example due to poor vision or limited decision-making capacity. Staff were able to describe how to request people’s consent before assisting them. Consent was kept under regular review. Staff were aware that people had the right to refuse care or part of their care and always checked with people before supporting them with their care.

At the previous inspection people's capacity was not always assessed, and this meant their liberty may have been compromised. During the current inspection we saw that people had mental capacity assessments completed to determine if they needed support to help make important decisions. This ensured people's rights were protected, and they were not deprived of their liberty. Information was shared with other professionals only on a need-to-know basis. The breach had been met.

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement: This meant people were not always supported and treated with dignity and respect; and involved as partners in their care.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. People told us they were treated with kindness and compassion. We observed some staff supporting people with kindness. However, in one person’s bedroom we noted there were offensive mal odours, and when discussed with a staff member they told us “I can’t smell anything I have a cold.” This would not have been a pleasant environment for the person sleeping in the bedroom.  We spoke to the registered manager who took immediate remedial action to ensure the mal odours were addressed.

In a shared bathroom we observed the toilet bowl and seat to be soiled and unclean. There were no soap or handtowels at the sink beside the toilet as a visual prompt to encourage people to wash and dry their hands after using the toilet. The registered manager told us there was wall mounted soap and drying materials round the corner by the shower. But the sink is where a person would be washing their hands not in the shower.  Having a visual prompt would better support the persons needs and help with maintaining their hygiene.

Staff told us they treated people as individuals. Staff were able to give examples of how they treated people with dignity and respect including ensuring privacy and treating people with respect. However, we observed the curtains in a person’s bedroom were not very secure with hooks missing and not covering the entire window. There was a large gap between the curtain and wall which would compromise their privacy with people passing the house or coming to the front door as the window was on the ground floor at the front of the house. Staff told us the person pulls their own curtains so maybe that is why it was loose.  We spoke to the registered manager who told us the staff will be more vigilant in future to ensure people’s privacy and dignity were maintained at all times

On another occasion we noted that staff had not supported the person with their toileting needs, resulting in their discomfort and a poorly fitted continence aid that had become ineffective. This impacted on the person’s dignity and comfort. We spoke to staff who told us, “He just used the toilet, and the pad was not put on properly so had dropped and was ineffective” The staff member then proceeded to support the person.’ When staff are delivering person-centred care means they would be diligent, notice this and address the issue to protect the person’s dignity.

The provider listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress. People were treated as individuals. We reviewed care plans for three people with a range of needs. Care plans were very detailed, and person centred. The care plans contained information about people’s lives and their life history. The care records contained specific likes and dislikes, preferences, and choices. The registered manager told us they are investing in a new electronic care record system as the current records are very large and unwieldy. This will improve and streamline assessment and reviews records.

The provider promoted people’s independence, so they knew their rights and had choice and control over their own care, treatment and wellbeing. People were encouraged and supported to maintain their independence and make decisions about their daily lives in line with their abilities. For some people giving limited choices helped them as given too many choices made it difficult to retain all options. People were encouraged to take as much control over their lives as possible this helped reduce their reliance on staff support.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. During an we observed a person’s care needs had not been addressed and this compromised the dignity and respect of the person. We spoke to the registered manager about this, and staff have been reminded that people’s needs must be a priority whatever else is happening at the service at the time.

Staff were aware of how to respond when people’s needs changed. A staff member told us that sometime there is a lot going on at the same time, and it is all about prioritising, what needs to be addressed now and what the next priority is. A staff member told us they enjoyed the variety. A professional who supported a person told us, “I have found the staff to be helpful and intuitive when supporting my service user”.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. The management team worked cohesively to achieve good quality care for the people they supported. Likewise, the staff team were well supported. Staff told us they felt valued and listened to. Staff felt they were able to speak to the registered manager and would be listened to.  Regular staff meetings were held as well as individual one to one meetings. These provided staff and managers with opportunities to discuss a variety of topics including people they were supporting training, updates and any shared good practice.

Responsive – this means we looked for evidence that the provider met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement: The provider did not always make sure people were at the centre of their care and treatment choices.

When discussing the planned refurbishment, a staff member told us “We have not decided yet whether to have flooring or carpet.” The person whose room the staff member was referring to was not involved in the conversation or in any decisions about what type of flooring they preferred in their bedroom.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. People were cared for by a small team of care staff who they knew well. Each person had their own key worker who had oversight and responsibility for ensuring information was up to date and current. Staff told us how they enjoyed working with a small group of people. A staff member told us, “We can really get to know the people we support. We work in partnership with other services which means people get joined up care.”  The key workers had weekly meetings with the service users, and these meetings were used to discuss all aspects of peoples support plans and any personal goals and or aspirations.

The provider made sure that people could access the care, support and treatment they needed when they needed it. People were given information relating to the service provision and what they could expect from the service. People’s individual communication needs were considered to make sure that they received information in their preferred formats. Staff were aware of people’s preferred communication methods and where required, specialist training was available.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. People, and their advocates felt their views were considered and respected. Professionals and key workers were invited to discuss individual current care and to review if the person would benefit from any additional or specialist support. There was a complaints procedure in place, and people were supported if they needed to raise any concerns. Verbal and written complaints were recorded, investigated, and responded to. Any learning from complaints was shared with all staff to help reduce any reoccurrence. At the time of our assessment there had not been any complaints made in recent months.

The provider made sure that people could access the care, support and treatment they needed when they needed it. Care, support and treatment were delivered safely and equitably, with no discrimination based on protected characteristics. People's individual needs were recognised and respected, and the provider sought feedback to identify and address any barriers that might affect access to care. Staff understood and complied with the legal equity and human rights to ensure people received personalised inclusive care. Staff were recruited based on their ability to do the job and not on their ethnicity or personal beliefs.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. The management and staff team described what equity in outcomes meant and how they supported people to access whatever services they needed to and be treated fairly as the same as a person who did not have specific needs. A staff member told us, “People should be supported and encouraged to reach their full potential, irrespective of any special needs and or disabilities.”

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. The registered manager told us they had collated as much information as possible as part of their live history which provided good oversight into their future wishes. Following the assessment the registered manager told us she would speak to people individually to make sure any special future wishes were known. Information such as religious beliefs were recorded in people’s care plans, in the event of them becoming unwell they would support individuals according to their wishes.

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained the same.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people with a disability and autistic people and their communities There was a lack of strategic oversight and direction. This impacted on the standard of care and the availability of opportunity for people to explore different things for example volunteering or work placement, co production of Systems and processes within the home. For example. supporting people to be responsible for tasks within the home, like checking the fire alarm giving them some responsibility and enhancing their everyday living tasks. Without a clear strategy rooted in transparency and engagement, the service lacked the leadership needed to create an environment where people felt valued and understood.

The provider and registered manager did not always understand the context in which they delivered care, treatment and support or embodied the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. We spoke to the registered manager about our findings and while she responded it appeared that there were several inaccuracies in the response. This meant that the version of events described by staff were not always accurate. The staff team worked closely with external partners including professionals with expertise in supporting people with a learning disability, GP’s district nurses and other health care professionals.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff told us they felt able to speak up if something was not working well and the registered manager was open to suggestions. All staff gave positive feedback in relation to the management team. A staff member told us, “I feel listened to and that my opinion matters.” Another staff member told us, “We are comfortable challenging team members, and it works both ways.”

The provider valued diversity in their workforce that was an inclusive environment that reflected a range of backgrounds, experiences, and perspectives. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

People were cared for by staff from different ethnic backgrounds and a staff team who were aware of diversity and what it meant in the workplace. The service was inclusive and where everyone belonged. For example, staff were able to talk about people’s religious and or ethnic backgrounds and were interested in diverse cultures.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with staff and others when appropriate. We found there was a lack of management oversight in particular outside of usual office hours. We observed several issues that would not align to person centred, dignified and compassionate care.  This lack of leadership presence during evenings and weekends meant that people did not receive consistently high standards of care, that they could expect to receive. We spoke to the registered manager about this, and she told us that the staff on duty had individual meetings to address the lack of person-centred care, and this was being monitored going forward.

The provider completed a wide range of audits on the quality and safety of the service. Audits viewed showed detailed criteria, clear responsibility, and actions when issues had been identified. An action improvement plan was in place and following the assessment the registered manager told us they had arranged a holiday for residents to enable the redecoration and refurbishment of the home.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The staff team had developed good partnership working with other professionals and partners. This helped provide holistic care that was joined up and seamless.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research. The registered manager told us they are constantly striving to make improvements that were sustainable. There was little evidence to support this strategy.