CQC report explained · a residential care home
What the CQC found at Langbury House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments and care plans did not always give correct or consistent instructions for choking, eating and drinking, epilepsy and emotional distress. There were also weaknesses in safeguarding systems, although medicines, infection control, recruitment and staffing arrangements were found to be safe.
- Effective?
- Good
- This question was not inspected during this focused inspection. The previous comprehensive inspection rating was used.
- Caring?
- Requires improvement
- People were not always treated with dignity and respect, offered choices or involved in their care. Inspectors also found delays in responding when some people became distressed.
- Responsive?
- Good
- This question was not inspected during this focused inspection. The previous comprehensive inspection rating was used.
- Well-led?
- Requires improvement
- Quality checks did not identify or prevent important problems. Staff turnover, vacancies, low morale and weaknesses in communication affected leadership and the quality of care.
What inspectors found, November 2022
Rated Requires Improvement; inspectors found serious weaknesses in risk management, safeguarding, dignity and leadership.
This was an unannounced focused inspection. Inspectors visited the home on 6 and 7 October 2022. They spoke with four people, seven staff members, six relatives and health and social care professionals. They also reviewed care, medicine, training and management records.
Inspectors found that risks linked to choking, eating and drinking, epilepsy and emotional distress were not always assessed or managed safely. Some staff did not follow important instructions. There had also been allegations of physical and psychological abuse. Staff involved had been suspended while investigations by the provider, local authority and police continued.
People were not always treated with dignity, offered choices or supported in a personalised way. Management checks had not found or prevented these problems. Medicines, infection control, recruitment, staffing levels and fire safety were areas inspectors found to be managed safely.
The overall rating fell from Good at the previous inspection to Requires Improvement. This inspection looked only at Safe, Caring and Well-led. The Effective and Responsive ratings were not inspected and carried over from the previous comprehensive inspection.
Medicines
Medicines were stored, administered and recorded safely. Stock control and disposal arrangements were also effective.
“Medicines were safely managed. Staff were recording administration of medicines accurately and consistently to help show people's medicines had been given as intended.” from the report
Staffing cover
Although there were vacancies, the home used regular agency staff and senior staff from elsewhere to maintain staffing levels and supervision.
“The provider was employing regular long-term agency staff with suitable training, and staff and management were covering staffing vacancies to ensure enough staff were deployed on each shift” from the report
Recruitment
The recruitment files checked showed that required checks, references, employment histories, induction and supervision processes had been completed.
“We reviewed a selection of permanent and agency staff recruitment files and saw that recruitment, induction and supervision processes had been followed as per the provider's systems and policies.” from the report
Infection control
Inspectors were assured that the home used infection control measures, including safe admission arrangements, hygiene practices and personal protective equipment.
“We were assured that the provider was using PPE effectively and safely.” from the report
Unsafe risk management
seriousCare plans and risk assessments were incomplete or inconsistent. Staff sometimes supported people in ways that had been identified as unsafe, including preparing food in a way that increased choking risk.
“Staff were supporting people in ways which were identified as being unsafe in their choking risk assessments.” from the report
Safeguarding delays
seriousStaff did not always report or challenge suspected abuse quickly. This delayed action to protect people while allegations of physical and psychological abuse were investigated.
“Staff had not always acted to challenge or report suspected abuse concerns quickly when they had been allegedly occurring” from the report
Dignity and respect
seriousSome people were left without an explanation, moved without being told what was happening, or had staff enter their rooms without knocking. The provider was in breach of the dignity and respect regulation.
“We saw some staff not treating people in a dignified way. People in wheelchairs were moved sometimes without explanation about what was happening and why.” from the report
Weak management checks
needs fixingAudits did not identify or prevent problems with risk management, safeguarding, records and learning from incidents. Staff turnover and vacancies also affected morale and performance.
“These had not always identified or prevented issues occurring or continuing at the service.” from the report
Inconsistent culture
needs fixingStaff and relatives described low morale, poor communication and a lack of agreement about expected standards. This affected the consistency of person-centred care.
“There was not always a positive, inclusive and empowering culture at the service.” from the report
- 01What has changed in the risk assessments and staff training for choking, eating and drinking, epilepsy and emotional distress?
- 02What was the outcome of the safeguarding investigations, and how are people now protected from abuse or improper treatment?
- 03How do managers check that staff treat people with dignity, explain what they are doing and use each person's preferred communication method?
- 04How have staff vacancies, agency cover and staff turnover affected care since this inspection?
- 05What evidence can you show that audits now identify problems with care records, safeguarding and risk management?
This was a focused inspection of Safe, Caring and Well-led only; Effective and Responsive were not inspected and their previous ratings were carried over. This explanation was written from the published report of 17 November 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2021
Rated Good; inspectors found safe, kind and personalised care at this first inspection.
The inspection was unannounced and took place on 23 March 2021. Inspectors spoke with people living at the home, relatives, staff and professionals. They also observed care and checked care, medicines, staff and management records.
The home supported four adults with complex learning disabilities, autistic spectrum conditions and other health needs. Inspectors found enough staff, safe medicines systems, suitable risk assessments and good infection control arrangements during the COVID-19 pandemic.
People were treated with kindness, dignity and respect. Staff knew people well, supported communication in individual ways and encouraged independence, activities and relationships. The home also worked well with health professionals and relatives.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. This was the home's first inspection since registration, so there was no earlier rating to compare it with.
Respect and dignity
Staff respected people's privacy and dignity during personal care and visits. Inspectors saw staff communicate patiently and respectfully.
“People's privacy, dignity and confidentiality were respected by caring staff.” from the report
Personalised communication
Staff used people's individual communication systems, including eye gaze, electronic technology, body language and gestures.
“People were given information in a way they could understand.” from the report
Promoting independence
The home adapted its equipment and routines so people could take part in everyday tasks and develop skills.
“Model of care and setting maximises people's choice, control and Independence.” from the report
Safe medicines
Medicines were stored, given and recorded safely. Staff giving medicines had training and competency checks.
“Medicines were received, stored, administered and disposed of safely.” from the report
Good partnership working
The home worked with health professionals and other agencies to support people's health and reduce avoidable hospital admissions where possible.
“The management team were open to new ideas and had formed good partnership working and relationships.” from the report
Inspectors raised no specific concerns in this report.
- 01How would you support my relative's particular communication method and help them make everyday choices?
- 02What training and competency checks do staff have for my relative's medicines and health needs?
- 03How would you support my relative to take part in activities and maintain relationships outside the home?
- 04How are risk assessments and care plans reviewed when a person's needs or behaviour changes?
- 05How would relatives be involved in decisions, complaints and any changes to their relative's care?
This was an unannounced planned first inspection covering all five key questions, including infection prevention and control under Safe; there was no previous rating. This explanation was written from the published report of 21 April 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Langbury House
2 rated inspections over 2 years: the service has slipped, from Good to Requires improvement.
- November 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- April 2021GoodSafe: GoodCaring: GoodWell-led: Good
- May 2019
Registered with the Care Quality Commission on 23 May 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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28 live-in carers within about an hour of West Sussex
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Most charge £1,020 to £1,170 a week. 23 can care for a couple. 11 years' experience on average.
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