The inspection was carried out on 9 October 2017 and was unannounced. Langdale is registered to provide personal care for up to 19 older people. Accommodation is provided in single and shared rooms some of which have en-suite facilities. The home is situated in the Bierley area of Bradford. At the time of the inspection there were 17 people living in the home.

The last inspection was in October 2016 and the service was rated ‘requires improvement’ overall. We found one breach of regulation in relation to Good Governance (Regulation 17). At this inspection we found improvements had been made with better documentation kept. For example in relation to the management of medicines.

A registered manager was in post who had worked at the home for a number of years. 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 and relatives spoke positively about the home. They said good quality care was provided. People said the staff team were friendly and kind and the registered manager was approachable.

Medicines were managed safely. People received their medicines as prescribed and clear records were kept demonstrating the support people had been provided with.

People said they felt safe. Safeguarding procedures had been followed to help protect people from harm. Risks to people’s health and safety were assessed and measures put in place to keep people safe. These measures were regularly reviewed.

The premises were safely managed with appropriate checks undertaken to the building. The décor in some areas of the building was tired and would benefit from decoration.

There were enough staff deployed to ensure safe and prompt care. The staff team were seen to respond quickly to people’s requests for assistance. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

People praised the staff who supported them. Staff received a range of training and support to give them the skills to do their role effectively. This included regular supervision.

People had access to a suitable choice of food. Nutritional risks were assessed and measures put in place to protect people from harm.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

The service worked with a range of health professionals to help ensure people’s healthcare needs were met.

Staff treated people with kindness, compassion, dignity and respect. People were listened to and there was a friendly atmosphere within the home. Where possible, people’s independence was promoted.

People’s care needs were assessed and used to formulate detailed and person centred plans of care. These reflected people’s needs and preferences. Staff knew people well and their plans of care which gave us assurance they were consistently followed.

An activities co-ordinator was employed who worked at the home five days a week, and provided people with a range of activities and social opportunities.

People and staff praised the way the home was run. They described it as personalised and friendly and said the registered manager dealt with any issues that arose. We saw the staff team worked well together.

Audits and checks were undertaken by the management team to monitor how the service was performing. People’s feedback was sought and used to make improvements to the service.

Langdale Residential Home provides personal care for up to 19 older people. The home is situated in the Bierley area of Bradford. The accommodation is provided in mostly single rooms with a small number of double rooms. Some rooms have en-suite facilities. The home has a range of communal areas including lounges, dining room and gardens.

The inspection took place on 5 October 2016 and was unannounced. On the day of the inspection there were 18 people living in the home.

A registered manager was in place. 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 this inspection we checked whether improvements had been made to the service since the last inspection in October 2015 where we found a breach of regulation and rated the provider as ‘Requires Improvement’ overall. We found some improvements had been made but areas remained that required attention. Overall, medicines were managed in a safe way with people receiving their medicines as prescribed. However recording arrangements were not consistently robust.

People and relatives spoke positively about the service and said it provided good quality care in a personalised and friendly way. We observed a positive and inclusive atmosphere within the home with people and staff getting on well.

Risks to people’s health and safety were assessed and appropriate plans of care put in place. We found the building to be homely and appropriate for people’s individual needs. Safety features were installed in the building to help keep people safe. We identified one concern with regards to fire safety which we referred to the Fire Service.

There were sufficient staff deployed to ensure safe care and treatment. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

People told us they felt safe using the service. Safeguarding procedures were in place which were understood by staff and the manager.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People said staff had the correct skills and knowledge to provide effective care. Staff received a range of training, supervision and support from the management team.

People praised the food provided by the home. There was sufficient choice and a person centred approach to mealtimes. People’s nutritional needs were met by the service.

People’s healthcare needs were assessed and met by the service in conjunction with a team of health professionals.

People and relatives said staff were always kind and caring and treated them well. Staff demonstrated a good understanding of the people they were caring for. Information on people’s lives had been sought to help staff provide individualised care.

People’s care needs were assessed and person centred plans of care put in place which were well understood by staff.

An activities co-ordinator was employed who provided people with a range of group and individualised activities and outings.

A system to log and respond to complaints was in place. People and relatives were highly satisfied with the service provided.

Systems to assess, monitor and improve the service were in place but these were not sufficiently robust, particularly in regards to medicine management and care records. We found some inaccuracies in care plan documentation which should have been identified and rectified through a programme of audit.

Systems to seek feedback from people who used the service were in place. People said they felt listened to and valued by the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. You can see what

Langdale Residential Home provides personal care for up to 19 older people. The home is situated in the Bierley area of Bradford. The accommodation is provided in mostly single rooms with a small number of double rooms. Some rooms have ensuite facilities. The home has a range of communal areas including lounges, dining room and gardens.

This was an unannounced inspection which took place on 27 October 2015. On the date of the inspection there were 15 people living in the home.

A registered manager was in place. 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 told us medicines were appropriately managed and we found people received their medicines at the time they needed them. However we found on a number of occasions stock levels of medicines did not tally with what was recorded within records. This meant we could not confirm people had received their medicines. In addition, the number of tablets administered to people and stock levels were not always recorded.

This was a breach of the Regulation 12 (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staffing levels were sufficient to ensure people were appropriately cared for and supervised. Staff had time to engage people in conversation as well as delivering care and support. Safe recruitment procedures were in place to ensure new staff were of suitable character to care for vulnerable people.

People told us they felt safe in the home and staff understood how to identify and act on concerns.

Risks to people’s health and safety were well managed. Risk assessments covered areas such as falls, mobility and any specific risks such as diabetes. Staff understood these assessments and how to protect people from harm.

The home was not consistently acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Although some DoLS applications had been made, possible deprivations of others people’s liberty had not been considered.

People had access to a range of healthcare professionals to help ensure their healthcare needs were met.

Staff received a range of support and training and told us it was effective in giving them appropriate skills to care for people within the home. People told us staff were knowledgeable about them and their individual needs.

We received mixed feedback about the quality of the food with some people saying choice and quality could be improved. Nutritional risks to people were generally well managed with snacks and drinks provided to people throughout the day.

Staff displayed a kind and caring attitude towards the people they were caring for. People all spoke positively about staff team and said staff treated and cared for them well. Care was delivered by an experienced staff team who knew people well and their individual likes, dislikes and preferences.

People had a range of care plans in place which demonstrated a personalised assessment of their needs had been carried out. Through our review of records, speaking with staff and people who use the service we concluded people received appropriate care that met their individual needs.

A programme of activities was delivered by the activities co-ordinator who worked in the home four days a week.

A system to manage and respond to complaints was in place.

People and staff spoke positively about the way the home was run. There was a friendly and inclusive atmosphere within the home.

At the last inspection in June 2014 we identified concerns with the way the service assessed and monitored the quality of the service. At this inspection we found some improvements had been made for example in the way quality surveys and some audits were conducted. However some audits were still not sufficiently robust for example medication audits. Clear action plans were not always in place where audits had identified issues to provide a structured approach to improvement.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.

We set out to answer the key question; Is the service safe? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

All the medicines people needed were available in the home. We saw that staff administered medicines in a safe, friendly way and respected people’s choices. Clear records about medicines were kept to ensure people’s safety. Medicines were disposed of appropriately; however disposal records in the controlled drugs register were not completed properly. A few medicines were not stored securely, allowing the possibility of mishandling or misuse.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

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

Safe

We found the home was clean, and free of unpleasant odours.

In the care records we looked at we saw people had risk assessments which covered areas of potential risk such as malnutrition, pressure ulcers and falls. When people were identified as being at risk, their plans showed the actions required to manage these risks.

There were procedures in place to guide staff on the actions to take in response to medical emergencies.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and was aware of the recent Supreme Court judgment on the Deprivation of Liberty Safeguards.

The provider had policies and procedures which related to the safeguarding of people who used the service. Staff had received training on safeguarding and were aware of the different types of abuse which people could experience. They were aware of how to report any concerns they might have about people’s safety and welfare. They said they felt confident the management team would address any concerns they raised about people’s safety and welfare. However, they were aware of the external agencies they could contact should it be necessary.

The people we spoke with told us they felt safe at Langdale and people’s relatives told us they had no concerns about people’s safety and welfare.

Effective

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

The home had good working relationships with other healthcare professionals and worked closely with them to make sure people’s needs were met. The input of other healthcare professionals involved in people's care and treatment was recorded in their care records.

Caring

One person who used the service told us “We are well looked after here”. We spoke with the relatives of two people who used the service and they told us they had no concerns about the care provided. One said “The care is good and the staff are kind, we like it because it is small and homely”.

Another relative said they had seen a great improvement in their relative since they moved into Langdale. They said their relative was taking more of an interest in life and was enjoying having their hair and nails done. Both people’s relatives told us they were kept informed and one said the staff were very good at explaining things to them.

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Responsive

People’s needs were assessed before they moved into the home. We saw people’s care records had information about people’s individual needs and preferences.

People told us there were activities for people who lived in the home however, one of the relatives we spoke with said they did not think there was as much entertainment for people as there used to be.

People’s relatives told us there were no restrictions on visiting and said they were always made welcome.

Well led

People told us the manager was approachable and listened to what they had to say. They said they would not hesitate to talk to the manager if they had any concerns and were confident their concerns would be dealt with.

The staff we spoke with said they enjoyed working at the home. They said they worked well as a team and felt supported by the management.

As part of the quality assurance monitoring process the service sent out survey questionnaires to people who used the service and/or their relatives to seek their views about the care and support they received. This gave people the opportunity to air their views and opinions of the service.

We found provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. We have asked the provider to tell us what action they are going to take to improve this aspect of the service.

We spoke with the registered manager about the provider's Statement of Purpose (SoP) and a copy was available and provided on request. We found the SoP included the necessary information including aims and objectives, the kinds of services provided, names of key individuals working for the service, legal status of the provider and details of the office address

We spoke with two people who lived at the home. They told us they received support at the times they needed it. One person said “I am happy and comfortable here, I have everything I need”. Another person said “I don’t have to wait for anything, I just have to ask staff and I get the help I need”.

People told us they they were treated with respect and felt safe living at Langdale Residential Home. One person said staff were “patient and supportive” another person said staff were “kind and polite”.

We spoke with two relatives of people who lived at the home, they told us they were happy with the care and support provided. One person said staff were “friendly and like family”. Another person told us staff “know what my relative’s needs are and how to support them”.

We spoke with the community matron who said they visited the home most days. They told us they had no concerns about people’s care and welfare and staff were “very knowledgeable” about people’s needs and always followed their advice and guidance.

We were not able to speak with people who used the service because most had complex needs which meant they were not able to tell us about their experiences. We used a number of different methods to help us understand people’s experiences, such as reviewing care records and observing care. We observed care in both of the lounges and saw people were spoken to in a respectful manner by staff. However, sometimes people were left waiting for support because staff did not regularly check people were alright whilst in the lounges.

One person who completed a survey about the service in July 2012 said their relative was ‘’settled and happy’’ living at Langdale Residential Home. Another person said there was a ‘’nice atmosphere and caring staff’’. We spoke with one relative of someone who lived at the home, they were very pleased with the care provided by staff and had no complaints.

Despite the positive comments people made. We found evidence care was not planned and delivered in a way that ensured peoples' safety and welfare. We also found people were not always protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We also found staff had not received appropriate training and support to ensure they could meet the complex care needs of people who lived at the home.

We carried out a routine scheduled visit to Langdale Residential Home on 31 May 2012. In view of the concerns identified in one outcome area the Care Quality Commission served a Warning Notice on the Registered Provider and the Registered Manager on 2 July 2012.

During our visit we spoke with four people who live at the home. They all told us that they liked living at Langdale and they were happy with the care and support they received. One person told us “I really like it here, there are no problems.”

During our visit we spoke with four visitors to the home. They all told us that they were involved in making decisions about the care and treatment that their relative received. They also said they were kept informed of any changes in their relatives needs. One person told us the service is “A home from home” for their relative.

People we spoke with were complimentary about the staff who worked at the home. They told us staff were kind, helpful and looked after them well. People and staff told us there was always enough staff to meet peoples’ needs. One person told us that their relative gets “One to one contact” whenever they need it.

Whilst the people we spoke with were satisfied with the care provided, we found other evidence that caused us to note some concerns regarding the care and welfare arrangements that could affect people living at the home.