This inspection took place on 29 November 2018 and was unannounced.

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

The Langley’s provides care and accommodation for up to 15 older people. There were eight people living in the home at the time of our visit. In response to the concerns identified at our previous inspection visit, the provider had taken the decision not to admit further people into the care home, hence the reduced numbers of people at the home when we visited.

At our last inspection in February and March 2018 we found there were improvements needed in all the key questions we inspected these were Safe, Effective, Caring, Responsive and Well led. There were five breaches of regulations at that time and we rated the service 'Inadequate' overall. The service was placed into ‘Special Measures’. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as ‘inadequate’ overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service is required to have 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 and associated Regulations about how the service is run. The previous registered manager had left their employment in August 2017. A new manager had been in post for approximately 11 months. They had submitted an application to apply to register with us and this was under consideration.

Systems and processes to monitor the quality of the service had improved from the previous inspection. Action had been taken to address the high-risk fire safety concerns previously identified. However, there were some health and safety risks and risks associated with people’s care that had not been sufficiently addressed. This included risks associated with staff recruitment as procedures in place had not been followed to ensure staff were recruited safely.

Information about how staff should manage risks associated with people’s care was not always clear although staff knew people well and were aware of these risks. Some care records did not contain accurate information but they were more detailed to help staff provide care and support in accordance with people’s wishes and preferences.

People received their medicines when they needed them and action had been taken following the last inspection to improve medicine storage. Some improvement was needed to medicine records to ensure risks associated with medicine management were safely managed.

There were enough staff on duty to meet people’s needs in a timely way and people were positive in their comments of the care and support they received. Staff told us they had completed training they needed to carry out their role but training records needed improvement to demonstrate this.

Both people and staff spoke positively about the manager and provider and people told us they felt safe living at the home. People told us about improvements made to décor and further improvements were planned.

The home was clean and staff understood what action to take to protect people from the risk of infection.

People told us there was now more to do to occupy their time. The frequency and range of social activities had increased so people had more opportunities to engage in activities they enjoyed. Activities to support people living with dementia rem

This inspection took place on 14 February and 12 March 2018 and was unannounced on both days.

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

The Langley’s provides care and accommodation for up to 15 older people. There were 10 people living in the home at the time of our first visit and 11 people during our second visit.

At our last inspection in November 2016 we found there were improvements needed in four of the key questions we inspected these were Safe, Effective, Responsive and Well led. No breaches of regulations were identified at that time. We rated the service 'requires improvement' overall. During this inspection improvements had not been made to improve the ratings and we identified additional areas needed improvement. We have therefore rated the service as ‘Inadequate’.

The service is required to have 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 and associated Regulations about how the service is run. Since our last inspection the management at the home had changed. The previous registered manager had left their employment in August 2017. A new manager had been in post for three months at the time of our visit and was in the process of applying to register with us.

Systems and processes had not been established or managed effectively to monitor, assess and improve the quality and safety of the services provided. The provider had not identified or taken action to mitigate risks in relation to the fire safety at the home which placed people at serious risk. We formally wrote to the provider and asked them to take immediate action to reduce these risks. Sufficient action was taken and this was confirmed by the Fire Safety team. Some health and safety risks in the home had not been identified and managed to keep people safe. The home was not clean and staff practices did not always protect people from the risk of infection.

Most people received their medicines when they needed them but the storage of medicines was not safe. Medicine audits took place but had not identified areas that required improvement.

Risk assessments to manage risks associated with people’s care were not effective. Some information recorded was incorrect and important information was not always available to support staff to provide safe, consistent care.

There was not enough staff on duty to meet people’s needs in a timely way. The system the provider used to assess how many staff were needed to support people safely was not effective. Staff had not completed all of the training they needed to meet people’s individual needs. Staff members spoke positively about the manager and provider but told us they would feel more supported if more staff were on duty.

People’s rights were not always protected because the provider continued not to work in line with the requirements of the Mental Capacity Act (2005). Staff did not demonstrate to us they understood the principles of the MCA but they did seek peoples consent before they provided assistance.

The provider did not understand the requirement of their registration which placed people at risk of harm. Assessments of people’s needs took place before people moved into the home but these assessments had not gathered enough information to ensure people’s needs could be met at the home. People told us they had not been involved in planning and reviewing their care.

The information contained with people’s care plans was not sufficient to support staff to provide care in-line with people’s preferences and wishes. The arrangements t

This inspection took place on 2 and 8 November 2016 and was unannounced. The Langleys is registered to provide personal care for up to 15 older people. At the time of our inspection there were 12 people living in the home.

During our last inspection on 6 October 2014, we found the provider was not fully meeting the standards required. This applied to the standards related to “Effective” and “Well Led”. This meant we allocated an overall rating of “Requires Improvement”. During this inspection we found that whilst some improvements had been made and overall people were happy with the service they received, some areas continued to need improvement and additional areas for improvement were also identified.

There was a registered manager in post who was registered with us in July 2015. This manager had previously worked in the home in the registered manager’s position for several years but had left and returned. 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 they felt safe living at the home. The provider carried out a range of recruitment checks to ensure staff employed were safe and suitable to work with people. Risks associated with people’s care had been identified but records and communication processes were not always clear to ensure staff knew how to respond to risks in order to maintain people’s safety.

Medicines were stored securely but medicine records did not demonstrate people always received their medicines as prescribed. Audit processes had not been effective in identifying errors.

Care staff at The Langleys completed catering duties in addition to providing care to people. This impacted on their time and meant there were times of the day when staff were particularly busy. Despite this, people felt there were enough staff on duty to meet their care needs and there were enough staff to keep people safe. However, staff had limited time to support people’s social care needs to provide person centred care. The atmosphere in the home was quiet with people relaxing either in the communal areas of the home or their rooms. During mealtimes people came together and there was social interaction between people and staff.

People felt staff had the skills and experience required to meet their needs. Staff completed training on an ongoing basis to help them develop their skills and competence to carry out their role safely and effectively. Staff understood their roles but were not always clear what was expected of them in regards to the completion of records. Staff were supported by the registered manager through one to one supervision meetings and staff meetings. People felt staff were caring and were positive in their comments of staff. Staff aimed to support people’s privacy, dignity and independence but this did not always happen.

The registered manager and staff had some understanding of the Mental Capacity Act but the principles of the Act were not always followed. It was not possible to determine whether people had the capacity to make decisions that impacted on their care and people were not always involved in these decisions.

People said they had enough to eat and drink and there were meal choices provided each day. Where people were at risk of poor health, due to not eating or drinking enough, there were processes to monitor their food and how much their drank to help ensure their health was maintained.

Visitors were made to feel welcome at any time to help people to maintain relationships with people important to them. People felt at ease to raise any concerns with the registered manager. However, the complaint procedure had not been updated to ensure people had access to the

This was an unannounced inspection carried out by two inspectors on 2 October 2014. At the previous inspection in January 2014 the provider was meeting the required standards.

The Langleys provides accommodation and personal care for up to 15 older people. The building is divided into three floors. There were 11 people living at the home on the day we visited.

The home is required to have 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. The service did not have a registered manager in post and had not had one since April 2014. A manager had been appointed in April but at the time of this inspection had not applied to register with us.

People told us they felt safe and were happy living at the home. Staff understood their responsibilities around keeping people safe and had a good awareness of what constituted abuse or poor practice. People told us there were enough care staff to meet their needs. People told us they enjoyed their meals and had enough to eat and drink during the day. There was a safe procedure for managing people’s medication, this showed people received their medication as prescribed.

Care plans provided staff with the information they required to provide safe and effective care to people. There was a process in place to review and update care plans, not all the care plans we looked at had been reviewed when people’s needs had changed.

Staff were knowledgeable about the care and support needs of people and understood the risks associated with people’s care and welfare. Staff had completed the required training to work with people safely. The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) but it was not always clear how people who needed assistance to make decisions were supported.

People had good relationships with staff. Staff took time to sit and talk with people and we saw them singing and laughing together. Staff were friendly and caring with people.

People said staff listened to them and their care was provided in the way they preferred. We saw staff responded promptly to requests from people for assistance and encouraged people to maintain their independence. People’s care had been arranged around their individual needs and preferences.

Staff were kept up to date about any changes in people’s needs by a handover meeting when they came on shift. The handover procedure did not support staff, who were not present at the meeting, to have up to date information about changes to people’s care needs. This could result in people receiving inappropriate care.

People told us they liked living at the home. Staff enjoyed working in the home and felt supported by the manager and the provider. They said the manager was knowledgeable and always approachable.

There were systems in place to monitor the quality of the service, this was through feedback from people who used the service, their relatives, staff meetings and a programme of audits.

During our inspection we spoke with five people and a visitor to the home. Some people were limited in being able to express their views of the service due to their health conditions. People and the visitor we spoke with told us, “It isn’t too bad at all.” “I am quite happy here, it’s very nice.”

We saw people sitting in the lounge watching television or sitting in the dining room reading. People looked well cared for.

People we spoke with were satisfied with the food provided. They told us, “It’s good I suppose, you get a repeat (referring to meals being repeated).” “That’s alright (food).” People told us they could have a drink when they wanted one and we saw drinks being provided during the day. We saw the main meal of the day looked appetising, this was served at lunchtime.

We saw medicines were being stored and managed appropriately. People had been given their medicines as prescribed to maintain their health.

Staff told us they completed training on an ongoing basis. We saw records confirming staff had completed mandatory training such as moving and handling and infection control. The manager had identified where further training was required for staff and this had been arranged.

There were systems in place to manage complaints. Complaints received had been investigated and acted upon appropriately.

We made an unannounced visit to The Langleys on 23 August 2012. Our inspection was to check whether the provider had taken action to improve the cleanliness of the care home.

In April 2012 we found that The Langleys did not provide a clean environment for people using the service. We told the provider they must make improvements and they sent us an action plan telling us what they were going to do.

During our inspection on 23 August we spoke with four out of the seven people who were using the service at the time. People told us they were satisfied with the service they received at The Langleys. Their comments included, “They keep the place clean”, “I think it’s a comfortable place.”

We also spoke with the manager and two care staff. We looked at some records relating to the running of the home, such as cleaning schedules and staff rosters.

We toured the home and looked particularly at communal bathrooms, lounge and dining areas and most of the bedrooms.

We found the standards of hygiene and infection control at The Langleys had improved

We decided to inspect this service because information shared with us raised concerns about the standards of cleanliness in the home.

We made an unannounced visit to this care home on 12 April 2012. There were eight people using the service when we visited. We spoke with six of these people and spent time observing their experiences in the care home.

We looked at three people’s care records and spoke with the owner and three care staff. We looked at some records relating to the running of the home, such as the staff duty rota.

The people we spoke with told us they were satisfied with the care and support they receive. Their comments included,

“I like it here because I can go out every day.”

“I get everything I need”

“They feed me well! I can have a cup of tea or a snack anytime I feel hungry.”

We observed that staff treated people respectfully. People were addressed by their preferred names and staff were discreet when asking about care needs. Staff gave sensitive explanations when they were helping people, speaking to them at a pace and level appropriate to their individual needs.

We found that care plans are available for people’s identified needs, which should mean that people get the care they need. People were supported to maintain their personal appearance. They had been prompted to choose coordinating clothing, their hair, skin and nails looked clean.

We saw that people were not left unattended for extended lengths of times. There was a staff presence in communal areas. We saw staff sitting and chatting with people when they were not involved in a task to meet a particular care need. People appeared to be comfortable in approaching staff with their requests and staff responded quickly. We found there were enough staff to meet the needs of people currently using the service.

We toured the home and looked at the lounge and dining areas, bathrooms and several bedrooms. We looked at the recommendations made by the Infection Prevention and Control Matron following her visit to the service in February 2012. We saw that significant progress had been made to improve the environment, but we are still concerned about the standards of cleanliness in some parts of the home. We have told the provider they must make improvements. We have asked them to tell us what they are going to do about it.

We made an unannounced visit to this care home on 2 December 2011.

There were 12 people using the service when we visited. We spoke with six of the people who were using the service when we visited and spent time observing their experiences in the care home.

We looked at three people’s care records and spoke with the owner, the manager and two care staff. We looked at some records relating to the running of the home, such as staffing rotas. We toured the home and looked at the lounge and dining areas, bathrooms and several bedrooms.

We found that people using this service are treated respectfully and enabled to make choices about their daily lives.

We observed that the personal appearance of people using the service varied. We saw some people who were well presented and groomed and wore clothes they had been supported to choose themselves. However, we saw some other people who had dirty fingernails, food around their teeth or dentures. Some people’s clothing looked stained and creased. Some of the men were unshaven and looked unkempt. The manager said that although most people using the service were physically independent, they needed encouragement and psychological support to motivate them to maintain their own personal hygiene.

There are systems in place to respond to suspicion or allegations of abuse to make sure people using the service are protected from harm.

We saw that staff were knowledgeable about people’s needs and their likes and dislikes and were kind and caring towards them.

Staff working in the home undertake cooking, cleaning and laundry as well as meeting the personal care needs of people. We found there were not enough staff on duty to meet people’s needs effectively.

People using the service have some opportunities to have their say about the running of the home, but improvements are needed in the way the provider monitors the quality of service people receive.

We have asked the provider to tell us the action they will take to address our concerns.