About the service:

Langdown House is a ‘care home’. 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. At the time of our inspection 26 people were living in four individual houses in the cul de sac. Langdown House consists of four separate houses, each containing seven bedrooms. Langdown House supports people with different needs and backgrounds, including people with learning disabilities, mental health needs, autism spectrum disorders and people who display behaviours that challenge others.

The service is run by YMCA London South West, a charitable organisation responsible for managing this service and another care home in the county of Surrey. However, the staff were employees of Surrey County Council. The two organisations worked in partnership with different roles and responsibilities for managing the service.

People’s experience of using this service:

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Langdown House was made up of four small houses. Each of these had a staff team led by a senior support worker. The service was overseen by a deputy manager and a registered manager.

People and relatives spoke highly of the service they received from Langdown House. The service had strong person-centred values and placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences.

During our inspection we identified a restriction was in place for people surrounding the access to the fridge and freezer at night time. This was discussed with the registered manager and the restriction was lifted immediately after the inspection where this restriction was not specifically necessary. The registered manager’s understanding of the Mental Capacity Act 2005 was thorough and other than this, people were supported in the least restrictive way possible.

Staff knew people well and worked hard to enable them to share their views, make choices and live active lives as independently as possible. The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; people’s support was focused on them having as many opportunities and choices as possible.

People were fully involved in the planning and delivery of their care and this was done in a way which encouraged independence. People’s care plans contained personalised information which detailed how they wanted their care to be delivered.

Risks to people’s health, safety and wellbeing were assessed and acted upon. We found a risk assessment for one person had not been completed to give staff clear direction on how to minimise the risk to this person. However, staff knew people’s needs well and were taking action to protect people. Following our inspection the registered manager sent us copies of the updated risk assessment they had put in place for this person.

People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

People were supported by kind and caring staff who worked hard to promote their independence and sense of wellbeing. Staff were provided with the training, supervis

The inspection took place on 23 and 30 August 2016 and was unannounced.

The last inspection took place in September 2013 when we found the service was meeting all the regulations we inspected.

Langdown House provides accommodation and support for up to 28 people living with a learning disability. Accommodation is provided in four seven-bedded houses located together in a small residential close. The service was run by YMCA London South West, a charitable organisation responsible for managing this service and another care home in the county of Surrey. However, the staff were employees of Surrey County Council. The two organisations worked in partnership with different roles and responsibilities for managing the service.

There were 24 people living at the service at the time of our inspection visits. Each house had a dedicated staff team, although staff spent time in the other houses so that they knew the people who lived there and could provide cover for other staff if required.

There was a new 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 and associated Regulations about how the service is run.

People using the service felt safe living at Langdown House and spoke positively about the support provided to them. They said staff treated them with kindness and respect. People were supported to lead active lives and maintain relationships with those who matter to them.

People received care and support from a group of staff who knew them well and understood their needs and preferences. Each person had individualised and detailed support plans to make sure they received the support they required. Assessments completed by the service identified any risks to each person and helped to safely promote their independence.

People were supported to have their health needs met. We saw that people’s prescribed medicines were being stored securely and managed safely.

The staff attended training which gave them the knowledge and skills to support people effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff had also received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by senior managers and acted upon.

People and their relatives felt able to speak to the registered manager or other staff to raise any issues or concerns. There were effective systems to monitor the quality of the service and obtain feedback from people and their representatives.

Residents told us that they enjoyed living at the home. They said that staff were available when they needed them and that they provided good support. Residents told us that staff treated them with respect when talking to them and when providing their support.

We found that residents had opportunities to be part of their local community, to enjoy active social lives and to pursue individual interests. Residents were encouraged to involve themselves in the routines of the home and to develop and maintain skills.

We found that residents were supported to stay healthy and to obtain treatment if they needed it. We checked the home’s arrangements for the management of medication and found that the provider had implemented measures to ensure that people received their medicines safely and that the potential for errors was minimised.

Staff told us that they had access to the training and support they needed to do their jobs. They said that they had opportunities to achieve further, relevant qualifications and to discuss their professional development.

We found that the provider had developed an effective system to monitor the quality of service that people received which included seeking the views of residents, relatives and staff.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We met a number of staff and people who used the service, observed the evening meal in one of the houses and spent some time with the people who used the service, including speaking to some of them individually.

We spoke with the manager and the deputy throughout the inspection and also interviewed two members of staff individually. We observed people relaxing in their home, interacting with staff and going out for various activities.

All of the views expressed by the people who live at the home were positive about the service they receive, as were the staff about the provider and the training and support they had received. They confirmed that they could choose their own meals and also clothing and take part in a variety of activities as they pleased.

Decision-making procedures and risk assessments were in place. Care plans were being developed and made more personalised and we saw evidence of this. There were procedures for managing emergencies and incidents and the staff team was skilled an experienced.

Having assessed the evidence we considered the service demonstrated how it met the safety and care needs of the people living in the home.

People felt they had control and choice over their life styles. They said staff supported them in learning and practicing life skills and encouraged them to maximise their independence. They described opportunities enabling them to influence decisions relating to the day-to-day running of their home. Staff supported them to clean and tidy their home, with their personal laundry, to plan menus and prepare their meals. Overall social, educational, employment and recreational activities met their expectations. They pursued personal interests and hobbies using mainstream services and facilities and had a choice of outings and holidays.

People told us a number of professionals and other agencies were involved in their care. Health needs were met by primary and specialist healthcare services. They were involved in planning and reviewing their care plans and able to self-direct their care and support, within individual levels of capacity.

People said they felt safe. They were encouraged to speak out at house and review meetings, also on a one to one basis with staff. If they had a concern or complaint they said they would inform staff and expressed confidence that staff would try to resolve their problems.

People said they liked living at the home. They were pleased about new carpets recently fitted in communal areas and looking forward to new settees being delivered. They had been introduced to the nominated individual on behalf of the provider, who was new in post. They had been informed that money was available to redecorate their houses and replace worn furnishings.

People told us they liked all of the staff including the managers, though one person said they didn’t always know care staff. They told us staff new to their house always worked with staff that knew them well and directed new staff in what they needed to do. They felt there was sufficient staff.