Archived: Langtree Park

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you wish to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The relatives we spoke with raised no concerns about people's safety and said if they had concerns they would discuss them with the manager. One relative told us, 'There are two of us who visit, we turn up when we like. None of us has ever seen or heard anything which has concerned us.' Another relative commented that their relative was able to verbally communicate with them and felt sure they would tell them if they were not happy.

We found people's capacity to make a decision was not clearly recorded. Where reference to people's capacity had been documented, it was unclear and there was no evidence to demonstrate that the principles of the Mental Capacity Act had been followed. There was no documented evidence to show how decisions had been made in the best interests of the person in the care plans we looked at.

Staff had received training in safeguarding and the home had policies and procedures in place to maintain people's safety. However, whilst the manager had reported and acted on a number of safeguarding situations we found some had not been formally referred to the local authority safeguarding team.

We looked at the recruitment of new staff. This showed that some required recruitment checks were not in place. These checks are necessary to ensure the suitability of the staff employed and to meet safe recruitment practice.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding people, safe recruitment and the Mental Capacity Act.

Is the service effective?

We found there had been an increase in staffing throughout the home. All of the six staff spoken with had received more training. This meant staff were more available and skilled in supporting people.

We looked at people's care records and found they did not give enough guidance to staff to ensure that people's needs could be met at all times. We found where risks were identified, the associated care plan did not give sufficient detail for staff to ensure people were kept safe. Some care plans we saw were illegible. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs.

Is the service caring?

During our visit we spoke with four people who all told us they were satisfied with the care and treatment they received. One person who used the service said, 'Its excellent here.' Another said, 'Everything is alright.'

We saw staff treated people with kindness and courtesy. We saw staff being warm and accepting of people. We saw people were well presented, they had co-ordinated clothes on, their hair was brushed and they wore appropriate footwear. This showed us staff had knowledge of the people they were caring for.

Staff were attentive to people's needs and were interacting with people whilst serving them their lunch. People were given choice and explanations of food. People who needed assistance were offered it in a sensitive way. One person we spoke with said, 'The food is very good.'

Is the service responsive?

We saw evidence of the work the manager and staff had carried out to meet the requirements set at the last inspection. They had drawn up an action plan and most of the work had been completed and they were in agreement of the further work that is needed to make sure that people living at the home can have their needs met at all times.

We saw the complaints log and saw most complaints made had been acted upon appropriately and any actions taken had been fed back to the person making the complaint. However a relative had to inform the manager that her mother's chair was not safe for her before action was taken by the home. It would be expected that staff would have noted the change in the person's seating, the consequent risk and acted upon it.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs.

Is the service well led?

The provider had supported the manager and assistant manager with the availability of senior managers to enable them to complete the actions requested at the last inspection.

We found staff knew their roles and responsibilities on two of the units and we discussed with the manager and operational managers the need for clearer leadership within the nursing dementia care unit.

Though not always consistent the service worked in partnership with key organisations, including the local authority, safeguarding teams and infection control to support care provision and service development.

Senior managers from the organisation carried out a monthly audit at the home to check standards and the quality of care being provided. However these visits did not highlight shortfalls in records thereby enabling these difficulties to be addressed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining safe and effective records and ensuring a more robust quality assurance.

We spoke with the acting manager, seven staff, four people and three relatives. We looked at documentation in relation to people's care and staff support.

We found continuing concerns in the management of people's care and welfare and it was still unclear who took responsibility for updating information in care records. We looked at the care records for seven people. We found these were not clearly completed and information was not accurately recorded. This meant people were not sufficiently protected against the risks of receiving care that is inappropriate or unsafe.

We saw some people with dementia presented with distressed behaviour at times. Staff did not demonstrate knowledge of people's backgrounds in order to purposefully involve or engage them in meaningful activity. Although staff were kind and patient with people, we saw limited interaction from staff, other than when they carried out care tasks.

We found there had been improvements regarding the management of medicines and the provider had taken sufficient steps to ensure this outcome was compliant.

We found continuing concerns with regard to supporting staff. Although progress had been made with the appointment of a new manager since our last visit, staff remained unclear as to the leadership arrangements in each unit. Staff were not adequately supported to enable them to deliver care and treatment to people in a safe and appropriate way. This was because staff had not received sufficient induction, supervision or training to carry out their roles.

We spoke with seven members of care staff. One staff member told us: 'This is a good team. We get along.' Other staff told us morale was very low due to the number of changes in the home over the past year.

People we spoke with who lived in the home and their relatives said were happy with the care and support provided. A relative told us: 'It's like we are part of a happy family.' However one person commented: 'The staff are always changing. You never know where you are.'

We saw not all people received care and treatment that met their needs. For example, we saw one person was constantly scratching. We saw this had been discussed with the GP and a cream had been prescribed. However, we saw this was not effective in controlling the person's discomfort. It was unclear from our discussions with staff and with the manager who took responsibility for identifying any changes in needs and ensuring those needs were met and the care records updated accordingly.

The medicines administration records were generally clearly presented. However we found a number of errors on people's records on the general nursing unit. The acting manager assured us prompt action would be taken to correct the issues found.

At this visit we observed people's experiences of living in the home and their interactions with each other and staff. During our observation we saw people looked clean and tidy and were relaxed and well cared for. People were wearing clean clothing appropriate to the temperature. It was clear from observations of staff interactions with people living in the home that they knew people very well. One person told us; 'The staff are always there quickly when I call them,' and a relative said; 'The care here is very good.'

People spoken with said they were happy living in the home and would not hesitate to raise concerns if they had any. We saw people looking comfortable when interacting with staff.

We spoke with five relatives visiting people on the two mental health and dementia units. All five expressed concerns about staffing levels on the units. One relative said; 'The staff really do have their hands full at meal times, they are very busy.'

People spoken with told us they felt able to speak out if they needed anything without the fear they would be discriminated against for making a complaint and believed the staff or the manager would act on their concerns.