About the service:

Langford and Kennet are two eight bedded units that are managed as one service and provide complex nursing care for people with neuro degenerative or previous brain injury.

Langford and Kennet are one of six adult social care locations at Glenside, which also has a hospital that is registered separately with CQC. 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.

Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. Some of the systems are managed centrally for all services; for example, maintenance, systems to manage and review accidents and incidents, and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site, also facilities such as the hydrotherapy pool are shared by people in all services.

One adult social care location (Pembroke Lodge) is currently closed as there were ongoing issues with the provision of heating and hot water.

The hospital is also currently closed due to flooding, caused by a major water leak. People from the hospital were transferred at short notice to some of the adult social care (ASC) locations. Works to repair the fabric of the hospital building are currently underway. As Langford and Kennet were temporarily accommodating people from the hospital we reviewed aspects of these peoples care and support in line with the expectations of their inpatient status. The Langford area is being used to accommodate people under the ASC registration and the Kennet area for those people previously accommodated in the hospital

The provider notified us of the temporary arrangements for hospital patients while refurbishments take place. However, Langford and Kennet will not be correctly registered with CQC if these arrangements become long-term. The provider will need to submit applications to CQC to register appropriately if the closure of the hospital continues.

At this inspection we found that people were placed at risk due to management shortfalls. We found systemic overarching poor management systems and that the required improvements were not prioritised. There had been sudden and continuing persistent changes of senior management. There was a lack of regulatory response from the provider. There were issues with poor recruitment procedures, and a lack of investment in equipment and maintenance of the property. The morale of the staff was low, and they were reluctant to give feedback because of fear of reprisals. This had an impact on the care people received.

People’s experience of using this service:

The service was rated Requires Improvement at the comprehensive inspection dated July 2018. The rating for the focussed inspection undertaken on the 7 November 2019 remained the same.

For people receiving adult social care we found:

• Staffing levels had improved since the last inspection.

• Information about pain management was not always clear.

• Three out of eight people living at Langford had a history of epilepsy seizures, however, epilepsy management training was non-compulsory.

• Environmental risk assessments relating to fire safety, infection control, maintenance or temperature check were out-of-date.

• There were no logs of maintenance work requested by staff or carried out in the service. We saw there were areas requiring urgent maintenance and potentially posing a threat to people’s health and safety.

• When agency staff were used, the service did not always ensure they were qualified and knowledgeable enough to lead a shift.

• The unit manager was not supported by the provider to ensure they could focus on making improvements. This included an ineffective maint

We undertook an unannounced focused inspection of Langford and Kennet on 7 November 2018. After the comprehensive inspection dated 11 and 12 July 2018 we received concerns in relation to staff not having appropriate checks before starting employment, language barriers of staff, poor working and living conditions for staff working as agency staff, competency of staff undertaking maintenance checks and lack of equipment across the Glenside Manor site. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Langford and Kennett on our website at www.cqc.org.uk.

The team inspected the service against two of the five questions we ask about services: is the service well led and safe. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Effective, Caring and Responsive through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Langford and Kennett provide nursing care for up to 16 adults with progressive neurological conditions. Langford and Kennett is one of six adult social care locations at Glenside which also has a hospital that is registered separately with CQC. The location of Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain. 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.

Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

A registered manager was 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 previous inspection dated 11 and 12 July 2018 we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider following the inspection to tell us how they were going to meet Regulation 12 and 17. The provider failed to report on the actions to meet Health and Social Care Act 2008, its associated regulations, or any other relevant legislation on how regulations were to be met At this focused inspection we found continued breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The CQC following the inspection formally requested under Section 64 of the Health and Social Care Act 2008 to be provided with specified information and documentation by 16 November 2018. We received some of the information requested but not all.

Quality assurance systems were inadequate. Audits were not robust and did not provide an accurate assessment of the quality of care delivered. Action plans were not developed to drive improvements. The CQC was not notified of accidents and incidents

At the inspection dated 14, 15 and 20 June 2017 this service was rated as Requires Improvement. We found the service had not complied with Regulations 9 and 12 of the Health and Social Care Act Regulations 2014. We found that support plans and associated care records were not person centred. Potential risks were not always identified and appropriately addressed. Following the inspection, the provider wrote telling us how compliance with Regulations 9 and 12 were to be met. At this inspection we found there had been some improvements but there were other breaches of regulation.

We inspected Langford and Kennet on the 11 and 12 June 2018. The inspection was unannounced on the 11 July 2018 and the provider was aware of the inspection visit on 12 July 2018.

Langford and Kennet 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. It is one of seven adult social care locations situated on one site, known as Glenside. The site also contains a hospital, which is registered with us separately.

At Langford and Kennet complex nursing care can be provided for up to 16 people with neuro-degenerative or previous brain injury. At the time of the inspection, there were 16 people using the service. Eight people were living at Langford and eight people were living at Kennet.

A manager was in post and in the process of becoming registered with CQC. 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.

This is the second consecutive time the service has been rated Requires Improvement.

Quality assurance and audit systems were not robust and did not cover all areas of care provided. The local improvement plan had identified shortfalls and all actions identified for improvement were met. For example, in October the action plan to develop person centred care plans and “ME” documents were met. However, during this inspection we found that some actions identified as met in the improvement plan remained unmet.

Audits were not used to assess all areas of service delivery. For example, when we asked about infection control audits we were told they were not necessary. This was because the issues were already known and actions were documented on meeting minutes. Although risk assessments detailed how risks were mitigated, the risk scores were misleading. Assessments and monitoring of risk may not be promoted due to low scoring for people at greatest risk. This meant that the provider may not have been alerted to emerging risks.

The staff used an online system for reporting accidents and incidents. Although safeguarding referrals were made for reportable abuse the provider had not notified CQC of all incidents. The manager reported to CQC in retrospect all incidents that affect the health, safety and welfare of people who use services.

Medicine systems were not managed safely and people were not having their medicines as prescribed. One relative said one person had not received their medicines on time for three consecutive days. We found gaps in the recording of medicines administered, some prescribed medicines were out of stock and there was a lack of clear guidance on administering “when required” medicines. Where medicines were to be administered outside recommended guidance there was a lack of confirmation from a pharmacist about these medicines. For example, medicines to be crushed. Some errors had not being reported. The staff that applied topical creams were not signing the Administration of Topical Medicine charts these were being signed by registered nurses. The mana

We carried out this inspection over three days on 14, 15 and 20 June 2017. The first day of the inspection was unannounced. Langford/Kennet is one of seven adult social care locations situated on one site, known as Glenside. The site also contains a hospital, which is registered with us separately. Langford/Kennet provides complex nursing care for up to 16 people with neuro-degenerative or previous brain injury. At the time of the inspection, there were 15 people using the service. Eight people were living at Langford and seven people were living at Kennet.

Langford/Kennet was registered as an adult social care location in October 2015. Previous to this, the location formed part of the overall site of Glenside. This was the location’s first inspection, as part of the adult social care directorate.

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. The registered manager had a dual role as they were also the registered manager of Newton House, another location on site. The registered manager was available throughout our inspection.

Risks to people’s safety were not always managed effectively. For example, staff had not identified one person had lost weight. They had not undertaken a nutritional assessment or regularly weighed the person. Despite the person being at risk of dehydration, fluid monitoring charts had not been consistently completed. This did not ensure effective monitoring to ensure the person consumed sufficient amounts. There was conflicting information within records regarding the person’s use of thickener for their drinks. This increased the risk of the person choking. The registered manager addressed this after it was brought to their attention.

Each person had a support plan in place. This clearly described the individual’s clinical needs and the support required. The information was comprehensive and detailed. However, other areas including continence and tissue viability contained less detail. One support plan was not an accurate reflection of the person’s needs. Wound care plans had not been written in a timely manner and there was no care plan regarding the person’s recent surgery. Other plans did not detail how people showed they were in pain and there were no pain assessments in place. Staff showed they knew people well but a person centred approach was not demonstrated within support plans. The registered manager was beginning to address this by introducing “getting to know me” meetings. The first meeting took place in October 2016.

People’s rights to privacy, dignity, choice and independence were promoted. However, this was not so for one person, as staff had not supported them to discreetly cover their catheter bag. Another person was upset that their bedroom door was always left wide open. This was addressed with the registered manager during the inspection and a satisfactory compromise was reached.

There were systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people. A traffic light system was used, which identified any shortfall and its level of risk. Records showed further checks were completed to ensure compliance. However, audits had not identified the shortfalls which were raised during this inspection.

Staff knew people well and positive relationships had been built. Staff showed a clear understanding of people’s needs and showed skill whilst communicating with those who did not use verbal speech. There was a clear ethos regarding improving people’s quality of life, which was adopted throughout the staff team.

Safe recruitment processes were in place and there were sufficient numbers of staff to support people