Care UK Community Partnerships Ltd are registered to provide accommodation, personal care and/or nursing care for up to 40 older people at Langley Oaks. However they are only contractually obliged by the commissioning local authority to provide personal and nursing care to people. Another service provider maintained the premises and equipment and provided the cleaning and laundry service and catering provision. Notwithstanding this arrangement, as the registered provider, Care UK Community Partnerships Ltd retains overall responsibility for ensuring all the legal requirements are met in relation to the accommodation, care and support provided to people. At the time of this inspection there were 36 people using the service. The service specialises in supporting people living with dementia.

At the last inspection of the service in September 2015 the service was rated Good. At this inspection we found the service remained Good.

People continued to be safe at Langley Oaks. Staff knew how to protect people from the risk of abuse or harm and followed the provider’s safeguarding policy and procedure for reporting concerns promptly. Risks to people's health, safety and wellbeing were assessed and reviewed and staff followed appropriate guidance to minimise these risks. Senior staff routinely analysed accidents and incidents to identify specific patterns of behaviour or poor working practices and processes that may have contributed to these. There were enough staff to keep people safe. The provider maintained recruitment checks to assure themselves of staff's suitability and fitness to support people.

Senior staff sought appropriate assurances from the service provider responsible for maintaining the premises, equipment, cleaning and laundry and the catering provision, that they had appropriate measures in place to ensure these aspects of the service did not pose unnecessary risks to people’s safety. The provider’s own staff followed good practice to ensure risks to people from poor hygiene and cleanliness were minimised. Staff also made sure the environment was clear of slip and trip hazards so people could move safely and freely around.

The provider maintained appropriate arrangements for the safe management of medicines. People received these as prescribed to them. People continued to receive support that was personalised and which met their specific needs. Staff used information and guidance, based on best available evidence and best practice, to plan and deliver care that would support people to experience good outcomes in relation to their healthcare needs. Staff respected people’s individual differences and supported them with any spiritual, religious or cultural needs. Senior staff reviewed people's needs regularly to ensure the support they received continued to meet these.

Staff received relevant training and felt well supported by senior staff. Staff knew people well and had a good awareness and understanding of their needs, preferences and wishes. They were aware of people’s communication methods and how they expressed themselves.

People were supported to eat and drink enough to meet their needs. People were also supported to access healthcare services when needed and staff liaised with other health and social care professionals to ensure people received effective coordinated care in regards to any health needs. Staff encouraged people to participate in activities and events and to maintain relationships with the people that mattered to them. Staff were warm and welcoming to visitors to the home and friends and families were free to visit when they wished.

Staff treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. People were encouraged to do as much as they could and wanted to do for themselves to retain their independence. People were asked for their consent before care was provided and prompted to make choices. St

This visit was a follow up from a previous inspection undertaken on the 23rd April 2013.

During that inspection we did not consider that the home was meeting minimum standards as laid out by legislation and therefore made two compliance actions. These actions required the provider to tell us in an action plan how they would meet the minimum standards. This inspection was undertaken to check they had complied with what we had required of them.

The compliance actions we made at our previous inspection related to safeguarding vulnerable adults and to supporting staff with training and supervision. After our visit we concluded that the provider had met the minimum standards required of them and therefore the compliance actions were removed.

To get a full picture of the home and how it functioned, the reader is advised to read this report in conjunction with the report written following our visit on the 23rd April 2013.

The home was accommodating 27 people on the day of our inspection. Two inspectors completed the inspection because of outstanding issues raised at the previous inspection, and current ongoing concerns. The home was open and transparent with the inspectors regarding the areas of concern identified.

We spoke to three relatives of people who used the service who in general were positive about the home and particularly the staff. One relative told us, “staff have always been really kind” and another relative told us, “staff are very dedicated”. The people who used the service that we were able to speak with told us “I’ve got no complaints” and someone else said, “it’s a laugh.”

During our visit we saw staff treated people who lived at Langley Oaks with respect and dignity. However, we found evidence that they may not always be adequately protected from abuse, or the risk of abuse. A relative we spoke with told us they felt their relative was not safe living at the home.

We also found that although the training staff received had improved in the past six months people’s needs may not always be fully met because the provider had failed to ensure that sufficient numbers of staff were properly supported.

We talked to the relatives of two people who use the service and they both told us all the staff that worked at the care home were always kind and caring. One relative said “Staff are fantastic”, and another told us “The staff here are amazing”. It was evident from staff practices we observed during our inspection that people receiving services in the home were well supported and treated with respect and dignity. When we visited the home we saw there were enough qualified staff working on each floor to keep the people who use the service safe. We found no errors on any of the medication records we scrutinised.

However, although all the visiting relatives we spoke with felt the home had improved in the past few weeks; we found the provider had failed to ensure there were always sufficient numbers of suitably trained and supported staff on duty in the home to effectively meet the health and welfare needs of the people who lived there.

We will revisit Langley Oaks to inspect what action the provider has taken to improve the service.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

During our review we spoke with ten people who use the service and two of their relatives and asked them what they thought about Langley Oaks. We also spoke with the registered manager of the home and six other members of staff, which included the senior nurse in charge of the shift, seven care assistants, and the cook. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also looked at a sample of records the provider is required to keep, which included care plans, weekly menus, the homes complaints procedure, and staffs personal files.

The majority of the feedback we received from people was positive about the overall standard of care and support provided at Langley Oaks. Typical comments we received from people who use the service and visiting relatives, included; “; ”I think the home is very good”, “the staff are all excellent”, and “the quality of the food is very good here and there’s usually lots of choice”.

All the feedback we received about the staff that worked at the care home was complimentary and we were told they always treated the people who lived there with respect. All the visiting relatives we met said the staff kept their loved ones safe.

Throughout our review we saw staff interacted with the people who use the service in a kind and courteous way.

All the meals we saw served during both breakfast and lunch were well-presented, looked nutritionally well-balanced, and smelt appetising.

The atmosphere in all three dining rooms we visited during mealtimes always felt relaxed and congenial.

We visited Langley Oaks on 7 and 8 September 2015.

The inspection was unannounced. The last inspection took place on 27 November 2013 during which made the service met the regulations we inspected.

The service provides residential care and support for up to 40 older people who may be living with dementia. At the time of the inspection there were 35 people living at the service and one person receiving respite care.

The service had a registered manager. 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 at the service felt safe. Staff had completed safeguarding of adults training and knew how to recognise and report abuse. They knew how to escalate concerns. The service provided a safe and comfortable environment for people, staff and visitors. People’s needs were assessed and appropriate risk assessments developed. There were sufficient numbers of staff to meet people’s needs and safe recruitment procedures were followed. There was an issue around infection control that was not the fault of the service and has been addressed since our inspection. People received their medicines safely and as prescribed.

Staff had the skills, knowledge and experience to deliver safe and effective care and support. The provider ensured staff were well trained. Staff were supported with regular supervision sessions and appraisals. Mental capacity assessments were completed to establish each person’s capacity to make decisions. Where it was necessary to deprive people of their liberty to deliver care and support the service had applied for authorisations under the Deprivation of Liberty Safeguards. Staff had completed mental capacity training. People were supported to have a healthy diet and to maintain good health. Individual needs had been met by the adaptation, design and decoration of the service.

People and visitors commented positively about relationships with staff. People and their representatives were supported to express their views and were involved in making decisions about their care and treatment. Staff respected people’s privacy and dignity and supported them to maintain as much independence as possible.

People received personalised care and support. Care plans were person centred and addressed a wide range of social and healthcare needs. Care plans and associated risk assessments reflected people’s needs, goals and preferences. People were encouraged to take part in activities that reduced the risks of social isolation. A wide range of activities were available to people. The provider had systems to obtain feedback about the quality of the service they provided in order to learn and improve.

Staff spoke positively about the management team who had an open door policy if people, visitors of staff wanted to speak with them. The service had a system of audits and checks to monitor and assess the quality of service they provided. The provider had a clear set of visions and values.