Langdale and Keswick (Parkfields)

About the service

Langdale and Keswick (Parkfields) is residential care home made of two bungalows providing personal care to seven people at the time of the inspection. The service can support up to eight people with learning disabilities and/or autism.

People’s experience of using this service and what we found

Right Support

Lessons were not always learned when things went wrong as incidents were not always thoroughly reviewed to ensure practice could be improved. Medicines were generally managed safely, and feedback was acted upon when areas for improvements were identified during the inspection. People were protected from the risk of cross infection, where possible. Staff enabled people to access specialist health and social care support in the community, although some improvements were needed to ensure advice was promptly followed.

Right Care

Staff understood how to protect people from poor care and abuse, however incidents were not always reported. The service did not always have enough appropriately skilled staff to meet people’s needs and ensure they led a fulfilling life. However, staff were recruited safely. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language) or objects of reference could not always interact comfortably with staff because staff did not always have the necessary skills to understand them. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. People were supported to have food and drinks in line with their choices and needs.

Right culture

People did not always receive good quality care, support and treatment because staff did not always feel they had sufficient training to effectively support people. People were not always supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. There had been a recent increased staff turnover, which meant people did not always receive consistent care from staff who knew them well. Despite this, relatives were positive about the support their loved ones received. The provider and registered manager were responsive to feedback and open to discussions about our inspection findings.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 4 April 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of ‘Right support, right care, right culture’. This was because we had received concerns about how people were being supported, so we wanted to check people’s care.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding, training of staff and quality assurance systems at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Langdale and Keswick (Parkfields) provides care and accommodation for up to 8 people in two separate bungalows. On the day of our inspection there were 8 people living at the service. The home provides residential care for people with a learning disability.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. 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 the last inspection on the 14 December 2016, the service was rated 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.

Why the service is rated good:

People were not all able to fully verbalise their views and staff used other methods of communication, for example sign language.

People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff were recruited safely and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults. There were sufficient staff to meet people’s needs and help to keep them safe.

People’s had their risks assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and competency checks to test their knowledge and to help ensure their skills in relation to medicines were up to date and in line with best practice.

People were supported by a staff team who had completed training to meet their needs effectively. Staff meetings, one to one supervision of staff practice, and appraisals of performance were undertaken. Staff completed the Care Certificate (a nationally recognised training course for staff new to care).

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 supported this practice.

People's health was monitored by the staff and they had access to a variety of healthcare professionals. The registered manager worked closely with external health and social care professionals to help ensure a coordinate approach to people’s care.

People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; taking into account people’s preferences and wishes.

Overall, people’s individual equality and diversity preferences were known and respected. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. Staff had built strong relationships with people who lived there. Staff respected people’s privacy. People, or their representatives, were involved in decisions about the care and support people received.

The staff remained responsive to people's individual needs and provided personalised care and support. People’s communication needs were known by staff. The provider had taken account of the Accessible Information Standard (AIS). The AIS is a requirement to help ensure people with a disability or sensory loss are given information they can understand, and the communication support they need.

Staff adapted their communication methods dependent upon people’s needs, for example using pictures. Information for people with cognitive difficulties and information about the service was available in an easy read version for those people who needed it.

People were encouraged to make choices about their day to day lives. The provider had a complaints policy in place and it was available in an easy read version. Staff knew people well and used this to gauge how people were feeling.

The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager was approachable and made themselves available. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

The provider worked hard to learn from mistakes and ensure people were safe. The provider and registered manager had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment. The previous rating was displayed in the main entrance.

Further information is in the detailed findings below.

Langdale and Keswick is a care home that provides personal care to people who have a learning disability. The home can accommodate eight people, with seven people living there at the time of our inspection.

There was a registered manager in post at the time 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’s safety was promoted through the provider identifying risks to people and then putting measures in place to ensure people were safe, while promoting their independence. People were supported by sufficient numbers of staff that knew them well. Staff understood how to identify potential abuse and protect people from harm. People received their medicines in a safe way. Staff were checked for their suitability to work with people before starting work at the home.

People were supported by staff who were skilled and knowledgeable. Staff were supported with on-going training and demonstrated they were able to put this into practice. People were asked for their consent before they received care and support, and we saw people’s rights were promoted. People could have the food and drink they wanted, this reflecting their preferences and needs. People were supported to have regular access to community healthcare.

We saw staff were kind, caring, and respectful to people. People’s individuality was recognised and respected. People’s dignity and privacy was respected. People made choices about how their care was delivered.

People were involved in planning their care, with support where needed. People’s views were sought when their needs and preferences changed. Staff understood how to deliver care that reflected the person’s individual needs and preferences. People were supported to live their life how they wished with support to access the wider community. People knew how to complain and had confidence complaints would be resolved.

The service was well led and people expressed confidence in staff and the provider. The provider has a clear ethos that was person centred, understood by staff and reflected how home was run. There were systems in place to capture people’s experiences and make changes based on what people wanted. Staff felt well supported, liked working for the provider and were happy in their work.

We saw people had been supported to consent to their care, and that arrangements for care had been explained to people in a way they understood.

People's needs had been assessed and care plans were detailed. These plans provided specific guidance to meet people's needs and reduce any risks to them.

People participated in a range of daily activities centred on their interests this supporting them in a lifestyle of their choosing. One person told us, 'I like to go out for pub lunches and the staff take me'.

People lived in a safe, clean and comfortable environment that had been suitably adapted to meet their needs. One person told us, 'I love my bedroom'.

People benefitted from staffing levels that met their specific needs and enabled them to engage in activities with the support they needed to be safe. One staff member told us, 'It's a lovely place to work. We have support from our manager, regular training and enough staff to support people'.

We saw people had access to a complaints procedure and systems were in place to seek their views and comments about their experiences. One such comment was, 'We couldn't ask for a better place'.

We looked at three people's care records and found these set out their support needs clearly and were updated regularly. What staff told us reflected what we saw recorded in people's records. This meant that people's care plans were up to date and staff understood what people's needs were.

People had regular contact with health professionals, this recorded and confirmed by people we spoke with. We saw people had health plans that clearly set out how their health was to be promoted.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We saw a comment from a relative in a survey form this saying, 'Staff are very supportive, well trained'. Staff told us they were well supported by the manager and they received regular and sufficient training that allowed them to do their jobs well.

People who used the service, their representatives were asked for their views by the provider. One person told us that it was a, 'Very happy home'.