Langdon Community - Edgware

Not everyone using ‘Langdon Community – Edgware’ receives regulated activity. CQC only inspects the service being received by people provided with ‘personal care’, meaning help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were nine people using the service in this respect.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager. This 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 our last inspection of this service, in March 2017, we found three breaches of legal requirements. These were in respect of safeguarding people using the service from abuse, staff support and training and effective governance including for medicines management. The service was rated ‘Requires Improvement.’ The provider sent us an action plan in respect of the addressing the breaches. We undertook this inspection to check that the action plan had addressed the breaches. This was also a comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs and well-led.

We found the required improvements had been made. Allegations of abuse were being properly addressed and monitored, minimising the risk of concerns being repeated. There had also been good work to raise awareness of amongst people using the service and staff of hate crimes, discrimination and bullying.

Increased monitoring and further staff training and competency checks had helped to ensure that people were consistently supported to take prescribed medicines. Records of this were now being accurately kept.

Improvements had been made to systems for ensuring staff received appropriate training, regular developmental supervisions and annual appraisal which helped to ensure staff had the knowledge and skills needed for supporting people. We found weaknesses with ensuring new staff completed induction training and probation periods in a timely manner. However, the management team were starting to develop systems to address this.

The service was now demonstrating better overall governance, as systems for scrutinising service delivery risks and the quality of care had been reviewed and improved on. There was an accountable structure in place and there were processes in place to support continuous learning and improvement.

People we spoke with all praised the service. Comments included, “I think Langdon is the best” and “It’s a fantastic service.” Most relatives told us they recommended the service to others, and a community professional told us the service worked well with them in meeting people’s needs.

The service promoted people’s independence well. It continued to support most people to gain paid or voluntary employment. It promoted social inclusion and provided many recreational opportunities through which people using the service developed friendships. This enhanced people's quality of life.

Staff at the service were kind, caring and emotionally supportive. There were enough staff to provide people with their required support. This was usually through the same small team of staff, which helped positive and trusting relationships to develop and enabled people’s needs and preferences to be better understood and addressed.

People received personalised care that was responsive to their needs. There were systems in place to ensure people were supported to have choice and control of their lives and for support to be provided in the least restrictive way possible. There were a number of avenues by which people using the service and their relatives were involved in the development of the service.

The service paid attention to people’s safety. Risks were assessed and managed, to balance people’s safety with their freedom.

The service supported people with health and nutritional needs, including accessing healthcare professional advice and following it.

The service supported people’s individual communication needs. It had an extensive range of easy-to-read documents, used to help some people’s understanding of specific matters.

The service promoted a positive and inclusive culture that achieved good outcomes for people, particularly for social inclusion. The management team were approachable and supportive of people and the staff working with them. There were effective links with other agencies to support care provision and development.

The service listened and responded to people’s concerns and complaints. However, we have made a recommendation to improve the overall monitoring of matters raised in this area, to help ensure opportunities to improve the service are followed.

The provider is registered for this service to provide homecare and supported living services to anybody in the community. The service specialises in the care and support of younger adults who have a learning disability or autistic spectrum disorder, a mental health condition, or a physical disability. At the time of this inspection the agency provided support to 77 people in total, but we focussed on the service they provided to seven people receiving personal care support in their own homes. This included some people living in small supported-living schemes, and other people receiving stand-alone services in their own homes.

The service had a registered manager at the time of the inspection. 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 and their relatives praised the service and said that they recommended it to friends and family. Health and social care professionals reported that Langdon had supported people well.

However, we found some concerns around how the service ensured that people received high quality care. The service was not consistently safe as responses to allegations of abuse were sometimes not robust at ensuring situations would not be repeated. This was because actions agreed from two safeguarding investigations had not been completed.

We found that people’s medicines records were not always signed to show that they were provided with the necessary support, and that audits of these records were not consistently robust. Some staff giving medicines had not had their competency to do this documented.

Staff were not sufficiently supported to carry out their care roles and responsibilities, as mandatory training was not promptly completed for new staff. Many care staff had not completed training on their responsibilities under the Mental Capacity Act 2005, and on the Jewish ethos that was relevant as the service specialised in providing care and support to Jewish people. Records of regular developmental supervisions were not consistently in place for some staff, and annual appraisals had not occurred for most staff.

The service was not consistently well-led. Whilst there was a detailed developmental plan in place for the service that focussed on outcomes for people using the service, it had not identified most of the concerns we identified during this inspection. Some records about staff and the management of the service were not accurate and up-to-date. Service-wide scrutiny was not therefore comprehensive.

Despite these concerns, the service was responsive at empowering people. It had supported most people to gain paid or voluntary employment. It promoted social inclusion and provided many recreational opportunities through which people using the service developed friendships. This helped enhance people’s quality of life.

There was good support of people’s individual needs and preferences. People were well supported to develop skills and independence. The support had enabled some people to move to their own accommodation or a better quality of shared accommodation.

Staff were reported to be kind, caring and emotionally supportive. People were listened to, both individually and within group meetings. They were involved in decisions about their care such as through review meetings and staff recruitment processes.

There were enough staff to provide people with their required support, and staff recruitment processes were sufficiently robust. Most people were provided with the same small team of staff, which helped positive and trusting relationships to develop.

There was good attention to managing risks relating to people’s care and support. The service supported people with health and nutritional needs, for example, encouraging healthy eating practices for a number of people. People were provided with good support for complex healthcare needs.

Overall, the service had strong user-led values that were followed. The management team were approachable and supportive of people. The management team and quality auditing processes were developing in line with the ongoing growth of the service.

There were overall three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.